Disparities In Eye Clinic Patient Encounters Among Patients Requiring Language Interpreter Services

Abstract Background: Communication barriers are a major cause of health disparities for patients with limited English proficiency. Medical interpreters play an important role in bridging this gap, however the impact of interpreters on outpatient eye center visits has not been studied. We aimed to evaluate the impact of medical interpreters on eyecare patient encounters at a tertiary, safety-net hospital in the United States.Methods: A retrospective review of patient encounter metrics collected by our electronic medical record was conducted for all encounters between January 1, 2016 and December 31, 2020. Patient demographics, primary language spoken, need for interpreter and encounter characteristics including new patient status, patient time waiting for providers and time in room were collected. We compared these patient visit times by interpreter use, with our main outcomes being time spent with ophthalmic technician, time spent with eye care provider, and time waiting for eye care provider. Interpreter services at our hospital are typically remote (via phone or video). Results: A total of 202,895 patient encounters, of which 56,230 (27.7%) required an interpreter, were analyzed. After adjusting for patient age at visit and new patient status, patients requiring an interpreter spent between 1.7 to 4.5 minutes longer with the technician and 1.1 to 2.1 minutes with their ophthalmologist (p<0.01), dependent on language. Spanish speakers also spent on average 1.2 minutes longer waiting for their providers after the technician completely their work up than English speakers (p<0.01), but for other languages this difference was not significant. Limited English Proficiency patients with an interpreter needed were more likely to keep their appointment once it was made when compared to those patients not needing an interpreter, and more likely to have their allergies, problem list and medications reviewed during their visit. Conclusions: Interpreters have a statistically significant impact on the eye clinic patient encounter, but less than we expected. Eyecare providers must be aware of this to prevent negative impacts on patient care. Equally important, healthcare systems should consider ways to prevent unreimbursed extra time from being a financial disincentive for seeing patients who require interpreter services.