Comparing the use of physician time and health care resources among patients speaking English, Spanish, and Russian

BACKGROUND AND OBJECTIVES. The number of US residents with limited English proficiency (LEP) is 14 million and rising. The goal of this study was to e stimate the effects of LEP on physician time and resource use. DESIGN. This was a prospective, observational study. SETTING AND SUBJECTS. The study included 285 Medicaid patients speaking Eng lish (n = 112) Spanish (n = 62), or Russian (n = 111) visiting the General Medicine and Family Practice Clinics at the UC Davis Medical Center in 1996 -1997 (participation rate, 85%). Bilingual research assistants administered patient questionnaires, abstracted the medical record, and conducted detai led time and motion studies. MAIN OUTCOME MEASURES. We used seemingly unrelated regression models to eva luate the effect of language on visit time, controlling for patient demogra phics and health status, physician specialty, visit type, and resident invo lvement in care. We also estimated the effect of LEP on cross-sectional uti lization of health care resources and adherence to follow-up with referral and testing appointments. RESULTS. The 3 language groups differed significantly by age, education, an d reason for visit but not gender, number of active medical conditions, phy sical functioning, or mental health Physician visit time averaged 38+/-20 m inutes (mean+/-SD). Compared with English-speaking patients and after multi variate adjustment, Spanish and Russian speakers averaged 9.1 and 5.6 addit ional minutes of physician time, respectively (P < 0.05). The language effe ct was confined largely to follow-up visits with resident physicians (house staff). Compared with English speakers, Russian speakers had more referral s (P = 0.003) and Spanish speakers were less Likely to follow-up with recom mended laboratory studies (P = 0.031). CONCLUSIONS. In these academic primary care clinics, some groups of patient s using interpreters required more physician time than those proficient in English Additional reimbursement may be needed to ensure continued access a nd high-quality care for this special population.