Wennberg Erica, Mohmand Zuhal, D'Arienzo David, Majeed Grant Safa, Uleryk Elizabeth, Vyas Manav V, Wanigaratne Susitha, Guttmann Astrid
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA Netw Open. 2025 Jun 2;8(6):e2513906. doi: 10.1001/jamanetworkopen.2025.13906.
Patients with language barriers may experience difficulties accessing virtual care.
To synthesize the literature on the association between language barriers and use of and satisfaction with virtual care among adult patients and among caregivers of pediatric patients in high-income countries.
Four electronic databases, MEDLINE, Embase, PsycINFO, and Web of Science, were searched from inception to March 2023 using a combination of language and virtual care terms.
Eligible studies compared quantitative data on use of or satisfaction with virtual care among adult patients or caregivers of pediatric patients with or without language barriers in high-income countries.
Data were extracted by 2 independent reviewers using a piloted data extraction form. Risk of bias assessments were performed using the ROBINS-E tool. Data were synthesized by outcome type using random-effects meta-analyses stratified by primary vs specialist care and narrative synthesis. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline.
The primary outcomes were use of virtual care and satisfaction with virtual care among adult patients and among caregivers of pediatric patients with vs without language barriers.
In total, 41 studies were included, 35 with adult patients (N = 4 543 906) and 6 with caregivers of pediatric patients (N = 7921). Most studies (n = 38) were set in the US, and examined use of virtual care (n = 35). Adult patients facing language barriers had no significant difference in adjusted pooled odds of virtual vs in-person primary or specialist care use (adjusted OR [AOR], 0.91 [95% CI, 0.61-1.35]; n = 5; I2 = 95.0%) and significantly lower adjusted pooled odds of video vs telephone primary or specialist care use (AOR, 0.66 [95% CI, 0.52-0.85]; n = 5, I2 = 93.5%), with high heterogeneity. Restricting to specialist care, adult patients facing language barriers had significantly lower adjusted pooled odds of using virtual vs in-person (AOR, 0.78 [95% CI, 0.70-0.87]; n = 4; I2 = 0.0%) and video vs telephone (AOR, 0.62 [95% CI, 0.53-0.73]; n = 3; I2 = 0.0%) care, with low heterogeneity. Results for caregivers of pediatric patients were limited and showed no significant difference in odds of virtual vs in-person specialist care, with a wide confidence interval and high heterogeneity (OR, 0.62 [95% CI, 0.38-1.02]; n = 3; I2 = 91.2%). Results specific to primary care and results on other use of virtual care outcomes (eg, visit noncompletion) were inconclusive due to limited numbers of studies (eg, n = 2 studies reporting AOR of visit noncompletion for primary and specialist care, with I2 = 75.5% and 89.6%, respectively, for the corresponding meta-analyses). Results on satisfaction with virtual care, synthesized narratively, were limited and mixed. In studies of adult patients and caregivers of pediatric patients (n = 3 each), 2 of the 3 studies found no statistically significant difference in satisfaction, while 1 study found significantly lower satisfaction.
In this systematic review and meta-analysis, adult patients facing language barriers had no significant difference in pooled odds of using virtual compared with in-person care overall, and significantly lower pooled odds of using video compared to telephone care overall. Restricting to specialist care, pooled odds of using virtual care and video care were significantly lower among adult patients facing language barriers, with low heterogeneity. Further research on virtual care among individuals facing language barriers is needed, focusing on virtual primary care, patient satisfaction, and caregivers of pediatric patients.
存在语言障碍的患者在获得虚拟医疗服务方面可能会遇到困难。
综合关于高收入国家成年患者以及儿科患者照料者中语言障碍与虚拟医疗服务的使用及满意度之间关联的文献。
从数据库建立至2023年3月，使用语言和虚拟医疗相关术语的组合对四个电子数据库（MEDLINE、Embase、PsycINFO和Web of Science）进行了检索。
符合条件的研究比较了高收入国家中有或无语言障碍的成年患者或儿科患者照料者在虚拟医疗服务使用或满意度方面的定量数据。
由2名独立评审员使用预先测试的数据提取表提取数据。使用ROBINS-E工具进行偏倚风险评估。通过按初级护理与专科护理分层的随机效应荟萃分析和叙述性综合，按结果类型对数据进行综合。报告遵循《系统评价和荟萃分析优先报告项目2020》指南。
主要结局是有语言障碍与无语言障碍的成年患者以及儿科患者照料者在虚拟医疗服务使用和对虚拟医疗服务满意度方面的情况。
总共纳入41项研究，其中35项针对成年患者（N = 4543906），6项针对儿科患者照料者（N = 7921）。大多数研究（n = 38）在美国开展，且研究了虚拟医疗服务的使用情况（n = 35）。面临语言障碍的成年患者在虚拟医疗与面对面初级或专科护理使用的调整合并比值比方面无显著差异（调整后的比值比[AOR]，0.91[95%置信区间，0.61 - 1.35]；n = 5；I² = 95.0%），而在视频与电话初级或专科护理使用的调整合并比值比方面显著更低（AOR，0.66[95%置信区间，0.52 - 0.85]；n = 5，I² = 93.5%），异质性较高。限于专科护理，面临语言障碍的成年患者在使用虚拟医疗与面对面护理（AOR，0.78[95%置信区间，0.70 - 0.87]；n = 4；I² = 0.0%）以及视频与电话护理（AOR，0.62[95%置信区间，0.53 - 0.73]；n = 3；I² = 0.0%）方面的调整合并比值比显著更低，异质性较低。儿科患者照料者的结果有限，且在虚拟医疗与面对面专科护理的比值比方面无显著差异，置信区间较宽且异质性较高（比值比，0.62[95%置信区间，0.38 - 1.02]；n = 3；I² = 91.2%）。由于研究数量有限（例如，n = 2项研究报告了初级和专科护理就诊未完成的AOR，相应荟萃分析的I²分别为75.5%和89.6%），关于初级护理的具体结果以及虚拟医疗服务其他使用结果（如就诊未完成）的结果尚无定论。关于虚拟医疗服务满意度的结果，通过叙述性综合得出，有限且不一。在成年患者和儿科患者照料者的研究中（各n = 3项），3项研究中的2项在满意度方面未发现统计学显著差异，而1项研究发现满意度显著更低。
在这项系统评价和荟萃分析中，面临语言障碍的成年患者在总体上使用虚拟医疗与面对面护理的合并比值比方面无显著差异，而在总体上使用视频护理与电话护理的合并比值比方面显著更低。限于专科护理，面临语言障碍的成年患者在使用虚拟医疗和视频护理方面的合并比值比显著更低，异质性较低。需要针对面临语言障碍的个体在虚拟医疗方面开展进一步研究，重点关注虚拟初级护理、患者满意度以及儿科患者照料者。
