1
|
Bacchi S, Kovoor JG, Goh R, Gupta AK, Tan S, Ovenden CD, To MS, Moey A, Sanders P, Chew DP, Schultz D, Kovoor P, Kleinig T, Jannes J. Pre-stroke anticoagulation for atrial fibrillation in primary English speakers and non-primary English speakers: a multicentre retrospective cohort study. Intern Med J 2024; 54:620-625. [PMID: 37860995 DOI: 10.1111/imj.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Anticoagulation can prevent most strokes in individuals with atrial fibrillation (AF); however, many people presenting with stroke and known AF are not anticoagulated. Language barriers and poor health literacy have previously been associated with decreased patient medication adherence. The association between language barriers and initiation of anticoagulation therapy for AF is uncertain. AIMS The aims of this study were to determine whether demographic factors, including non-English primary language, were (1) associated with not being initiated on anticoagulation for known AF prior to admission with stroke, and (2) associated with non-adherence to anticoagulation in the setting of known AF prior to admission with stroke. METHODS A multicentre retrospective cohort study was conducted for consecutive individuals admitted to the three South Australian tertiary hospitals with stroke units over a 5-year period. RESULTS There were 6829 individuals admitted with stroke. These cases included 5835 ischaemic stroke patients, 1333 of whom had pre-existing AF. Only 40.0% presenting with ischaemic stroke in the setting of known pre-existing AF were anticoagulated. When controlling for demographics, socioeconomic status and past medical history (including the components of the CHADS2VASC score and anticoagulation contraindications), having a primary language other than English was associated with a lower likelihood of having been commenced on anticoagulant for known pre-stroke AF (odds ratio: 0.52, 95% confidence interval: 0.36-0.77, P = 0.001), but was not associated with a differing likelihood of anticoagulation adherence. CONCLUSIONS A significant proportion of patients with stroke have pre-existing unanticoagulated AF; these rates are substantially higher if the primary language is other than English. Targeted research and interventions to minimise evidence-treatment gaps in this cohort may significantly reduce stroke burden.
Collapse
Affiliation(s)
- Stephen Bacchi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Minh-Son To
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Moey
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Pramesh Kovoor
- Westmead Private Hospital, Sydney, New South Wales, Australia
| | - Timothy Kleinig
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jim Jannes
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Jenstad LM, Howe T, Breau G, Abel J, Colozzo P, Halas G, Mason G, Rieger C, Simon L, Strachan S. Communication between healthcare providers and communicatively-vulnerable patients with associated health outcomes: A scoping review of knowledge syntheses. PATIENT EDUCATION AND COUNSELING 2024; 119:108040. [PMID: 37951163 DOI: 10.1016/j.pec.2023.108040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE Summarize literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. METHODS Scoping review of reviews: systematically searched six databases. INCLUSION CRITERIA systematic searches and syntheses of literature; one or more providers and communicatively-vulnerable patients; synchronous in-person communication; intermediate or health outcome linked to communication. RESULTS The search yielded 14,615 citations; 47 reviews - with wide range of providers, communication vulnerabilities, communication practices, and health outcomes - met inclusion criteria. Methodology included qualitative, quantitative, and mixed approaches. Quality ranged from very low to high. Six categories of communication practices linked to health outcomes were identified: 1) motivation-based; 2) accommodation of language, culture, gender, sexual identity, and other concordance with the patient; 3) cultural adaptations of interventions; 4) use of interpreters; 5) other provider-patient communication practices; 6) patient communication practices. CONCLUSION Communication practices were studied in a wide range of providers, with common themes regarding best practices. A unique finding is the role of the patient's communication practices. The specificity of communication practices studied is heterogeneous, with many reviews providing insufficient details. PRACTICE IMPLICATIONS Motivation-based practices and culturally- and linguistically-appropriate care have impacts on patient outcomes across a range of settings with different professions and communicatively-vulnerable groups.
Collapse
Affiliation(s)
- Lorienne M Jenstad
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Tami Howe
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London SE10 9LS, UK.
| | - Jennifer Abel
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Paola Colozzo
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Gayle Halas
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Glenda Mason
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
| | - Caroline Rieger
- Department of Central, Eastern and Northern European Studies, University of British Columbia, Vancouver, Canada
| | - Leora Simon
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Shaelyn Strachan
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
3
|
Huwyler C, Merchant M, Jiang N. Disparities in Speech Therapy for Voice Disorders Between English- and Non-English-Speaking Patients. Laryngoscope 2021; 131:E2298-E2302. [PMID: 33559902 DOI: 10.1002/lary.29429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 01/26/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate whether language of choice affects compliance with speech therapy for voice disorders. STUDY DESIGN Retrospective chart review. METHODS A retrospective study was performed at Kaiser Permanente Northern California to compare compliance with referrals to speech therapy for voice disorders between English- and non-English-speaking patients. Patients referred from January 2012 through December 2017 were included. Logistic regression models were used to calculate the adjusted odds ratios (aOR) and to determine social and demographic factors affecting compliance. RESULTS Of 7,333 patients referred to speech therapy for a voice disorder, 7,171 were identified as English speaking and 162 as non-English speaking. The two cohorts were similar in terms of gender and proportion over 65 years of age, although non-English-speaking individuals were more likely to be Hispanic or Asian than English speakers, who were more likely to be White or African American. Overall compliance was lower among non-English-speaking patients than English speakers (63% vs 74%) (P = .0011). Logistic regression showed that the need for an interpreter was significantly associated with higher noncompliance (aOR 1.56, 95% CI 1.11-2.18), as was age less than 65 and income less than the study aggregate median income. Being multiracial or having a voice disorder of neurologic origin was associated with better compliance. CONCLUSION This study demonstrates significant noncompliance with speech therapy for a variety of voice disorders. This problem is exacerbated for patients who do not speak English and who are younger, of lower income, or are referred for functional voice disorders. In-person interpreters or multilingual speech therapists may help to improve compliance. LEVEL OF EVIDENCE IV Laryngoscope, 131:E2298-E2302, 2021.
Collapse
Affiliation(s)
- Camille Huwyler
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| | - Maqdooda Merchant
- Division of Research, Biostatistical Consulting Unit, Oakland, California, USA
| | - Nancy Jiang
- Department of Head and Neck Surgery, Kaiser Permanente, Oakland Medical Center, Oakland, California, USA
| |
Collapse
|