Patients who require language interpretation are less likely to initially choose a video tour – NCAL Research Spotlight


Kaiser Permanente research shows that once patients try to video talk to a clinician, they likely will do it again

By Jan Greene

Patients with limited English proficiency who need an interpreter for a telemedicine visit were less likely to choose a video visit for their first time than patients who did not need an interpreter, study finds by Kaiser Permanente published on November 4 in JAMA network open.

The study examined 995,352 primary care phone and video visits scheduled by 642,370 patients between March and October 2020 on the Kaiser Permanente Northern California (KPNC) website.

The authors found that among patients who had never used a video visit before, 29% of those who needed an interpreter chose video over the phone, compared to 36% of those who did not need services. interpreter. But after patients had their first video visit, there was no significant difference in the continued choice of video visits (47% needed an interpreter versus 49% who did not).

Loretta Hsueh, PhD, Research Fellow, Research Division.

Principal author of the study Loretta Hsueh, PhD, a Delivery Science Fellow at Kaiser Permanente Research Division, explained the results. Hsueh studies health care disparities and developed this research with research scientist DOR Mary Reed, DrPH.

Why have you studied how people who need language interpretation use video tours?

Hsueh: There has been a dramatic increase in the use of video tours by members of Kaiser Permanente after the start of the COVID-19 pandemic, and we wanted to know how people with limited English proficiency are navigating this change. . Telemedicine visits include conversations with a clinician both by phone and by video. The video has advantages, especially for people who use interpretation services, as it can show the clinician a rash or lump, and can also see the doctor using cues or non-verbal gestures, which can be important communication factors for people who do not share a language.

What did you learn from this analysis and why is it important?

Hsueh: We found that about 2% of patients requested language interpretation, and most of those who did were Hispanic / Latino or Asian, and were between 18 and 64 years old. About a fifth came from low socioeconomic neighborhoods.

This study did not explain why this group of people might be less willing to make a first video visit. They may not have been explained the value of a video tour or may not have easy access to the Internet. But reaching out to these particular patients to help them connect, to enroll them, and to log in for a first online session with a clinician seems to pay off in the long run.

The good news from this study is that we found that patients with or without the need for translation were more likely to choose the video after they had tried it at least once. This tells us that once patients try it, they see its value. This first video visit is really important, and we have to make it a good experience.

How do translation services for online doctor’s visits work?

Hsueh: KPNC was an early adopter of telemedicine and initially incorporated language translation using a phone service, so the interpreter would join the audio on a phone or video visit. But in mid-2021, KPNC added a new feature to video tours so that the performer can also appear as a video participant, potentially a major improvement in the care experience.

What else are you waiting to study on how patients use telemedicine?

Hsueh: We have great linguistic diversity among our Northern California members – there are approximately 100 languages ​​represented in our dataset. We are working on research that examines racial and ethnic differences in access to our website and telemedicine services by patients whose primary language is not English.

The pandemic and the way it quickly changed the way our members access care complicates our research. At the same time, the increase in the number of people using video tours has been positive for patient care, and Kaiser Permanente has been able to keep up with this rapid change. There will also be challenges that accompany this change, and we want to learn how to better serve all of our patients, not just those who are already engaged and doing well.


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