Language Access in Pharmacies

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Language Access in Pharmacies

• Linda Weiss, PhD
• The New York Academy of Medicine
• Emily M. Ambizas, PharmD
• St. Johns University, College of Pharmacy and
  Allied Health Professions

New York State Conference on Increasing Language
Access in Healthcare April 2007
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Presentation Focus

• The availability of prescription medication
  instructions in languages other than English,
  including
• Pharmacist provision of written prescription
  medication information
• Counseling in languages other than English
• Improving language access
• Methods for providing multilingual medication
  information
• Barriers to and facilitators of change
• Will be discussing our recent research, as well
  as more general information on language issues in
  a pharmacy context

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Language Access in NYS Pharmacies Legal
Considerations

• As recipients of federal funds in payment for
  medications, pharmacies may be subject to the
  requirements of Title VI of the 1964 Civil Rights
  Act.
• Pharmacies may be required to provide language
  access services to comply with the branding and
  counseling provisions governing pharmacy
  practice.
• Branding Medical labels or printed information
  must be rendered in a way that is likely to be
  read and understood by the ordinary individual
  under customary conditions of purchase and use.
• Counseling A pharmacist or pharmacy intern
  providing prescription services shall be required
  to personally counsel each patient or person
  authorized to act on behalf of a patient.
• Hospital-based pharmacies may be required to
  follow the directives of the NYS Language Access
  and Patients Rights regulations adopted in
  September 2006
• NYS pharmacies are required to print labels in
  English. They can print labels in a second
  language as well.

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New York City Demographics Foreign Born and LEP

• Approximately 2.9 million immigrants live in NYC,
  accounting for 36 of the Citys population
• Currently, immigrants and their children account
  for nearly 2/3 of the NYCs population.
• More than 1 in 4 adults in NYC do not speak
  English at all or do not speak it well.
• Almost ½ of LEP New Yorkers live in homes where
  no one speaks English well.

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New York CityLEP by Neighborhood
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Current Practice in NYC Results from a Survey
of Pharmacists

• Conducted a telephone survey of 200 randomly
  selected pharmacies from a list of all NYC
  pharmacies (2100) provided by the Office of
  Professions, NYS Education Department.
• Interviews were conducted with a pharmacist on
  duty.
• Survey included questions on
• Frequency and language of LEP customers
• Languages spoken by pharmacy staff
• Ability to print translated medication labels and
  leaflets
• Frequency of translations
• Other policies and practices regarding
  multilingual medication information
• Interviews were conducted between February and
  August 2006 and took about 5 minutes each to
  complete.

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Pharmacist Pharmacy Characteristics

• Pharmacy Type
• Independent 119 (59.5)
• Chain 71 (35.5)
• Hospital outpatient 7 (3.5)
• Clinic 3 (1.5)
• Pharmacist Birthplace
• USA/Canada/Puerto Rico 76 (38)
• Africa/Middle East 10 (5)
• Asia Pacific Islands 75 (38)
• Caribbean/S. America 11 (6)
• Europe 20 (10)
• Missing 8 (4)

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Limited English Proficient Pharmacy Patients

• Pharmacist Self-Report
• Daily LEP, any language 176 (88)
• Daily Spanish 156 (78)
• Daily Chinese 31 (16)
• Daily Russian 27 (14)
• Less than daily LEP 14 (7)
• No LEP customers 10 (5)
• Percent LEP in pharmacy census tract
• Mean 24.4
• Median 22.3
• Range 3.2 - 62.9

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Frequency of Translation of Written Materials

• Sample with LEP customers daily (n 176)
• Daily translation 63 (35.8)
• Weekly translation 22 (12.5)
• Never translate 44 (25.0)
• Dont know/missing 8 (4.5)

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Bivariate Associations with Daily
TranslationPharmacies with Daily LEP Customers
(n 176)
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Adjusted Odds for Daily Translation of Medication
Labels
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Pharmacy Capacity to Provide Medication
Information in Languages other than English
Most pharmacies (75) have dispensing software
with translation capabilities. 2 respondents
said they developed their own translation
software. 9 respondents said they handwrite the
translations.
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Translated Medication Labels Determining Who
Gets Them

• Can tell through interaction 108 (54.0)
• Language in customer record 20 (10.0)
• Customer requests translation 66 (33.0)
• Indicated on the prescription 14 (7.0)
• Sign in pharmacy 15 (7.5)
• Word of mouth 21 (10.5)

Four pharmacists reported that translated labels
are provided to all patients except those
requesting English only.
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Understanding Medication Information Why it is
important

• Information may be complex, including
• Dosing, frequency and duration
• Special instructions regarding food, liquids, and
  storage
• Side effects
• Implication of medication errors
• Reduced efficacy, side effects, drug resistance
• The significance of prescription medications for
  treatment of illness
• 1.3 billion medications were prescribed or
  provided during medical visits in 2002 alone
• Patients have day-to-day responsibility for
  medication management and recognition of adverse
  events

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Efforts Made to Provide Information in Multiple
Languages (more common)

• Utilization of dispensing software with
  translation capabilities
• Handwritten translated instructions
• Staffing with bilingual employees and/or language
  study
• Telephone interpreting using language lines
• Telephone medication counseling by bilingual
  pharmacists in other pharmacies
• On-line medication and health information in
  multiple languages (e.g. walgreensespanol.com)

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Efforts Made to Provide Information in Multiple
Languages (less common more costly)

• In-stores kiosks with health information in
  multiple languages
• Video-based interpretation services
• Direct video link between the patient and a
  remote translator
• Talking medication bottles with verbal
  instructions

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Barriers to Increased Language Access

• Pharmacists concerned about translating into
  languages they dont understand concerned about
  liability if there is an error
• Inadequacies in translation software
• Programs may only print one language at a time.
  May need to print two labels to have English and
  a second language
• Translations may be awkward, not grammatically
  correct
• Demands on pharmacists time are already very
  high. Some feel there is not time for
  translation
• Shortage of qualified bilingual staff
• Pharmacists attitudes and level of awareness

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Planned Next Steps
Improvement in language access at pharmacies
through

• Continuing education classes for practicing
  pharmacists
• Pilot interventions at selected pharmacies
• Review of label translations for accuracy and
  reliability
• Outreach to LEP populations

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Next Step Objectives
Increased

• Availability and awareness of dispensing software
  with translation capabilities
• Availability and awareness of telephone
  interpreting services
• Inclusion of patient language preference in the
  patient profile
• Signage and proactive efforts to inform patients
  of available language services

Decreased

• Use of ad hoc interpreters

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Project Staff Community Advisory Board Members

• Emily Ambizas, St. Johns University, College of
  Pharmacy and Allied Health Professions
• Elana Behar, The New York Academy of Medicine
• Tamar Bauer, Nurse Family Partnerships
• Sebastian Bonner, The New York Academy of
  Medicine
• Olveen Carrasquillo, Columbia University
  Department of Medicine
• Francesca Gany, New York University School of
  Medicine
• Adam Gurvich and Maysoun Freij, The New York
  Immigration Coalition
• Holly Lee, Charles B. Wang Community Health
  Center
• Robert A. Mangione, St. Johns University,
  College of Pharmacy and Allied Health Professions
• Priti Patel., St. Johns University, College of
  Pharmacy and Allied Health Professions
• Peri Rosenfeld, Visiting Nurse Services of New
  York
• Elyse Rudolph, Literacy Assistance Center
• Linda van Schaik, Bellevue Hospital Center
• Lauren Schwartz, NYC Poison Control Center
• Karen Scott Collins, NYC Health and Hospitals
  Corporation
• Iman Sharif, Albert Einstein College of
  Medicine/Montefiore Medical Center
• Linda Weiss, The New York Academy of Medicine
• ------
• Kate Liebman, Program Officer, Altman Foundation

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Contact information

• Linda Weiss, PhD
• Senior Research Associate
• The New York Academy of Medicine
• lweiss_at_nyam.org, tel [phone]
• Emily Ambizas, PharmD
• Assistant Clinical Professor
• St. Johns University, College of Pharmacy and
  Allied Health Professions
• arweilee_at_stjohns.edu, tel [phone]