Health Inequities for Patients with Limited English Proficiency & Gaps in Emergency Medicine Research

Madison Melton - Department of Emergency Medicine

 #emergencymedicine #EM #inclusiveresearch 

Up to “8% of the U.S. population” is thought to have Limited English Proficiency (LEP), a term that refers to a person who is not fluent in English, often because it is not their native language [1]. Yet comparatively, these patients face significant health inequities and barriers to accessing care. Many of these challenges are due to difficulties communicating with healthcare providers. Specifically, patients with LEP have a poorer understanding of their diagnoses. This increases medication errors, reduces treatment adherence and follow-up, and makes patients less satisfied with their care. These patients also have reduced access to routine medical care, including fewer visits with a general practitioner and inadequate preventative care. Consequently, the emergency department (ED) becomes their source of primary care.

In addition, patients with LEP are often omitted from clinical research, including in emergency medicine. This study evaluated the inclusion of LEP populations in acute care stroke research publications in the U.S. A systematic review was conducted, and “the primary outcome was whether language was used as an inclusion or exclusion criteria for study participation” [1]. Out of 167 studies, “13.2% indicated the use of language as an inclusion/exclusion criteria” and “only 10.2% explicitly included LEP patients” in the study [1]. These results highlighted how “LEP populations are not routinely incorporated in acute care stroke research” and that “few studies incorporate methodology specifically designed to include LEP subjects” [1].

Exclusion of any patient population from clinical research risks negatively impacting its usage for a larger group. Because LEP populations are often left out, it is important that current researchers bridge this gap by incorporating language-inclusive practices. This will help “ensure all patients are equitably represented in research studies and ultimately evidence-based practices,” leading “to a better understanding of disease prevalence, presentation, management, and outcomes of patients with LEP” [1].

References:

1. Zeidan, A.J., Smith, M., Leff, R. et al. Limited English Proficiency as a Barrier to Inclusion in Emergency Medicine-Based Clinical Stroke Research. J Immigrant Minority Health 25, 181–189 (2023). https://doi.org/10.1007/s10903-022-01368-y

Edited by Shlok Chauhan - Clinical Section Editor