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How Well do Spanish Speaking Patients Comprehend Discharge Instructions?

1 August 2006


Context: Spanish speaking patients at a family medicine clinic in Oregon are presumed to understand examination and discharge instructions, with the aid of an interpreter. Minority residents, specifically the Hispanic population, are increasing in Oregon. To adjust to these population changes medical providers may need to change their delivery method to aid the Hispanic population understanding and comprehension of medical information. There is limited information on whether there is increased or adequate understanding of verbal or a combination of verbal and written instructions.

Objective: This study investigated whether verbal instruction alone, or a combination of verbal and written instructions lead to adequate understanding in Spanish speaking patients. English speaking patients were evaluated as a control study. After each clinical encounter the patient was given a survey related to their understanding of procedures and discharge instructions. A one week follow up phone call was completed to reaffirm the patients' level of understanding of examination and post visit instructions. Patients were randomized in one of two groups based on which week they were scheduled to have their appointment, then assigned random numbers, based on eligibility and participation.

Study selection: Patients of eon ley Lynch M.D., and Michelle Stewart PA-C over the age of 18, either new or established English and Spanish speaking patients were considered as candidates for the study.i

Results: A total of 67 surveys were collected over a 5 week period of time, 36 English and 31 Spanish. Participants were both female and male, with ages ranging from 18-80. Spanish speaking patients showed a decreased ability to read, understand and speak English, versus English speaking patients who spoke at a "very well" level. Regardless of demographic data only 1.8% of Spanish speaking participants had trouble with how to take their medications. Participants who were referred for x-ray or blood work 100% knew the reason they were having additional studies done. And 100% of patients, who had a follow up appointment, knew the reason for follow up. Of the patients who were available for follow up phone calls 53.7% of participants knew their diagnosis and 16.4% did not know their diagnosis. With the addition of written instructions English group one had a 24% increase of those who knew their diagnosis. And Spanish group two had an increase of 20% compared to group one, which was still 9% higher then group two English. On average participants in group one (verbal) initially liked their discharge method, and felt it was easy to understand and did not have any trouble following instructions. However during the follow up phone call 20% of English speaking participants and 30% of Spanish speaking participants changed their minds. Group two patients on average liked their discharge instructions with no change during follow up phone calls.

Conclusion: This was a randomized study; patients were placed into study groups based on eligibility, willingness to participate and date encounter occurred. Providers at Maple street Clinic are being clear and precise with patients during discharge, and therefore patients are not having difficulty taking their medications and know why additional testing! laboratory are needed. The use of a combination of discharge instructions may be reaching more learning styles with the use of verbal (auditory) and written (visual). This also increased satisfaction and understanding in all group two participants. Providers at Maple Street may want to continue to give written handouts to Spanish speaking patients to increase understanding and emphasis diagnosis to patients without use of medical jargon.


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