Cheung Stephanie G, Mishkin Adrienne D, Shapiro Peter A
Division of Consultation-Liaison Psychiatry, Columbia University Medical Center, New York, NY.
Division of Consultation-Liaison Psychiatry, Columbia University Medical Center, New York, NY.
Psychosomatics. 2017 Jul-Aug;58(4):421-426. doi: 10.1016/j.psym.2017.02.006. Epub 2017 Feb 20.
In the United States, people with limited English proficiency (LEP) receive poorer medical care than those proficient in English. Few studies demonstrate how linguistic barriers complicate psychiatric care; in consultation-liaison (C-L) psychiatry, there are no published data about care disparities for patients with LEP or for whom English is not the preferred language (PL).
We sought to determine if PL affects the psychiatric consultation rate.
Among adult patients admitted during 1 year to a large urban academic medical center, we compared psychiatric consultation rates in English PL patients with non-English PL patients. PL was ascertained from demographics during the medical record. The occurrence of psychiatric consultation was ascertained from C-L service logs.
There were 54,534 admissions: the no-consultation group (N = 53,196) and the consultation group (N = 1,398). English as PL was more common in the consult group (72.0% of consult group, 62.0% of no-consult group, χ = 92.98, p < 0.0001). Spanish speakers were underrepresented in the consult group (14.2% of consult, 25.8% of no-consult, χ = 98.78, p < 0.0001).
Primary teams requested more consultations for patients whose PL was English than for patients with other PLs, suggesting that psychiatric needs of patients with non-English PL may be unaddressed. This is the first study to demonstrate a disproportionately low rate of general hospital psychiatric consultations in this population. Further study is necessary to confirm and understand this disparity. We recommend routine use of professional interpreters and low threshold for consultation in patients with non-English PL.
在美国，英语水平有限（LEP）的人比英语熟练的人获得的医疗护理更差。很少有研究表明语言障碍如何使精神科护理变得复杂；在会诊-联络（C-L）精神病学中，没有关于LEP患者或英语不是首选语言（PL）的患者护理差异的已发表数据。
我们试图确定PL是否会影响精神科会诊率。
在1年期间入住一家大型城市学术医疗中心的成年患者中，我们比较了以英语为PL的患者和不以英语为PL的患者的精神科会诊率。PL是从病历中的人口统计学信息确定的。精神科会诊的发生情况是从C-L服务日志中确定的。
共有54534例入院患者：无会诊组（N = 53196）和会诊组（N = 1398）。以英语为PL在会诊组中更常见（会诊组的72.0%，无会诊组的62.0%，χ = 92.98，p < 0.0001）。说西班牙语的人在会诊组中的比例不足（会诊组的14.2%，无会诊组的25.8%，χ = 98.78，p < 0.0001）。
初级医疗团队为PL为英语的患者请求的会诊比其他PL患者更多，这表明非英语PL患者的精神科需求可能未得到满足。这是第一项证明该人群综合医院精神科会诊率低得不成比例的研究。有必要进行进一步研究以确认并理解这种差异。我们建议对非英语PL患者常规使用专业口译员并降低会诊门槛。
