Health care delivered in a patient’s preferred language could decrease ED visits, hospitalizations and death

Long-term care residents whose primary language was a language other than English and French were less likely to visit the emergency department, be hospitalized or die when their family doctor spoke their language, according to new research from ICES.

Research has established that patients who face language barriers in the health care system often struggle to access services and receive care that is of lower quality and safety.

A new study examines whether these disparities can be attributed to language barriers. In a cohort of almost half a million people receiving home care services between 2010 and 2018 in Ontario, Canada, researchers defined “language concordance” as a patient who received primary care from a family physician who spoke their language.

The study titled, “The impact of patient-family physician language concordance on health care utilization and mortality among home care recipients receiving primary care in Ontario, Canada,” was published in BMJ Public Health.

While the risk of emergency department (ED) visits, hospitalizations and mortality decreased for Allophones—people speaking a language other than English or French—when they received language-concordant care, outcomes were no different for Francophones.

“Interestingly, outcomes for Francophones were not impacted by whether they received language-concordant or language-discordant primary care,” says Michael Reaume, resident physician in internal medicine at the University of Manitoba. “We think that the finding is because sixty-one percent of Francophones in the study did in fact receive care from French-speaking family doctors.”

“This means that relatively fewer Francophones were at risk of experiencing poor outcomes. For me, this suggests that policies such as the French Language Services Act have been successful at facilitating access to language-concordant care for the Franco-Ontarian population.”

Key findings:

• Most home care recipients were anglophone (80%) while francophones (2%) and allophones (18%) represented a minority of the cohort.

• Allophones who received language-concordant primary care experienced fewer ED visits (53% vs. 58%), hospitalizations (35% vs. 38%), and fewer died during the study period (14% vs. 17%), when compared with those who received language-discordant primary care.

‘”This study highlights the importance of systematically collecting both patient and physician language data,” says Reaume.

While physician language data is collected in most jurisdictions across Canada, only three provinces and territories (Northwest Territories, Nova Scotia, Prince Edward Island) have patient language data included on their residents’ health cards.

“This information is necessary to allow for matching of patients to physicians who speak their preferred language, and also to identify patients who would benefit from professional interpreter services when the former is not possible,” adds Reaume.