ACP Recommends Changes to Accommodate Multicultural Patients

As the nation's population continues to grow and diversify, the healthcare system still needs to change and adjust to meet the needs of an increasingly multicultural patient base, according to the American College of Physicians (ACP) in an updated paper released Monday.

Racial and Ethnic Disparities in Health Care, a revision to a policy paper that was originally released in 2003, looks at what further steps are needed to close the gap between racial and ethnic minority patients and their white counterparts.

"Closing the healthcare disparities gap will be a difficult, multifaceted, and important task," said J. Fred Ralston, Jr, MD, president of ACP, in a statement. "Overwhelming evidence shows that racial and ethnic minorities continue to be prone to poorer quality health care than white Americans, even when factors such as insurance status are controlled."

As the nation's population diversifies, one area of concern is cultural competency, which will become more important as clinicians are confronted with different belief systems that "influence their ability or patient receptivity to provider recommendations," the report states.

While only half of all patients generally adhere to medical or prescription instructions offered by clinicians, rates of adherence are significantly lower for racial and ethnic minorities, according to the report. Cultural competency is a key part of delivering patient-centered care that stresses "respect for the patient, clear communication, shared decision making, and building of the doctor-patient relationship."

Communication barriers—particularly language barriers—are a significant problem for many physicians, especially those who provide care frequently to Medicaid and other public insurance program beneficiaries. In one survey, 63% of hospitals and 54% of internal medicine physicians reported treating "limited English proficiency" patients at least weekly, and 84% of federally qualified health centers cared for these patients daily.

According to one ACP survey, internists reported seeing limited English proficiency patients speaking nearly 80 dialects and languages. Even after the influential 2002 IOM report "Unequal Treatment" highlighted the difficulties of communication between physicians and other health providers and patients with limited English proficiency, the problem has worsened among some groups.

To address this problem in part, all payers should provide funding for linguistic and interpretive materials and personnel. Currently, few private insurers cover the cost of language services, and Medicare does not reimburse for interpreters, the report noted. Only 12 states and the District of Columbia provide funding for interpreters for Medicaid and Children's Health Insurance Program beneficiaries.

In updating the recommendations from the previous policy paper's call to action, ACP also calls for:

• All legal residents should be provided with affordable health insurance.
• The healthcare delivery system must be reformed to ensure that patient-centered medical care is easily accessible to racial and ethnic minorities, and physicians are enabled with the resources to deliver quality care.
• Diversity in the healthcare workforce must be encouraged.
• Inequities in education, housing, job security, and environmental health must be erased if health disparities are to be effectively addressed.
• Efforts must be made to reduce the effect of environmental stressors that disproportionately threaten to harm the health and well-being of racial and ethnic communities.
• More research and data collection related to racial and ethnic health disparities is needed to empower stakeholders to better understand and address the problem of disparities.

 
Racial and ethnic disparities in healthcare present a difficult challenge that results from the interaction of multiple complex factors, for which there are no easy solutions," Ralston adds. "However we as physicians, and as a society, have a moral imperative that appropriate resources are devoted to responding to the challenge."