Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada
Introduction As the world’s linguistic diversity continues to increase at an unprecedented rate, a growing proportion of patients will be at risk of experiencing language barriers in primary care settings. We sought to examine whether patient–family physician language concordance in a primary care s...
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000762.full |
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| author | Claire Kendall Sharon Johnston Michael Reaume Peter Tanuseputro Michael Pugliese Douglas Manuel Denis Prud'homme Manish Sood Ricardo Batista Ewa Sucha Rhiannon Roberts Emily Rhodes Emily Seale Lise Bjerre Louise Bouchard |
| author_facet | Claire Kendall Sharon Johnston Michael Reaume Peter Tanuseputro Michael Pugliese Douglas Manuel Denis Prud'homme Manish Sood Ricardo Batista Ewa Sucha Rhiannon Roberts Emily Rhodes Emily Seale Lise Bjerre Louise Bouchard |
| author_sort | Claire Kendall |
| collection | DOAJ |
| description | Introduction As the world’s linguistic diversity continues to increase at an unprecedented rate, a growing proportion of patients will be at risk of experiencing language barriers in primary care settings. We sought to examine whether patient–family physician language concordance in a primary care setting is associated with lower rates of hospital-based healthcare utilisation and mortality.Methods We conducted a population-based retrospective cohort study of 497 227 home care recipients living in Ontario, Canada. Patient language was obtained from home care assessments while physician language was obtained from the College of Physicians and Surgeons of Ontario. We defined primary care as language concordant when patients and their rostered family physicians shared a mutually intelligible language, and we defined all other primary care as language discordant. The primary outcomes were Emergency Department (ED) visits, hospitalisations and death within 1 year of index home care assessment.Results Compared with non-English, non-French speakers who received language-discordant primary care, those who received language-concordant primary care experienced fewer ED visits (53.1% vs 57.5%; p<0.01), fewer hospitalisations (35.0% vs 37.6%; p<0.01) and less mortality (14.4% vs 16.6%; p<0.01) during the study period. In multivariable regression analyses, non-English, non-French speakers had lower risks of ED visits (adjusted hazard ratio [aHR] 0.91, 95% CI 0.88 to 0.94), hospitalisations (aHR 0.94, 95% CI 0.90 to 0.98) and death (aHR 0.87, 95% CI 0.82 to 0.93) when they received language-concordant primary care. For francophones, the risk of experiencing an ED visit, a hospitalisation or death was not impacted by the language of their family physician.Conclusions Patient–family physician language concordance is associated with a lower risk of adverse outcomes in non-English and non-French speakers. Optimising the delivery of language-concordant care could potentially result in significant decreases in the use of acute healthcare services and mortality at the population level. |
| format | Article |
| id | doaj-art-450ce773c2ca4f31bac01ec4917893e6 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Public Health |
| spelling | doaj-art-450ce773c2ca4f31bac01ec4917893e62025-01-28T22:35:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-04-012110.1136/bmjph-2023-000762Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, CanadaClaire Kendall0Sharon Johnston1Michael Reaume2Peter Tanuseputro3Michael Pugliese4Douglas Manuel5Denis Prud'homme6Manish Sood7Ricardo Batista8Ewa Sucha9Rhiannon Roberts10Emily Rhodes11Emily Seale12Lise Bjerre13Louise Bouchard14University of Ottawa Department of Family Medicine, Ottawa, Ontario, CanadaUniversity of Ottawa Department of Family Medicine, Ottawa, Ontario, CanadaInternal Medicine, University of Manitoba Max Rady College of Medicine, Winnipeg, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaInstitut du Savoir Montfort, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaUniversity of Ottawa Faculty of Medicine, Ottawa, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaInstitut du Savoir Montfort, Ottawa, Ontario, CanadaIntroduction As the world’s linguistic diversity continues to increase at an unprecedented rate, a growing proportion of patients will be at risk of experiencing language barriers in primary care settings. We sought to examine whether patient–family physician language concordance in a primary care setting is associated with lower rates of hospital-based healthcare utilisation and mortality.Methods We conducted a population-based retrospective cohort study of 497 227 home care recipients living in Ontario, Canada. Patient language was obtained from home care assessments while physician language was obtained from the College of Physicians and Surgeons of Ontario. We defined primary care as language concordant when patients and their rostered family physicians shared a mutually intelligible language, and we defined all other primary care as language discordant. The primary outcomes were Emergency Department (ED) visits, hospitalisations and death within 1 year of index home care assessment.Results Compared with non-English, non-French speakers who received language-discordant primary care, those who received language-concordant primary care experienced fewer ED visits (53.1% vs 57.5%; p<0.01), fewer hospitalisations (35.0% vs 37.6%; p<0.01) and less mortality (14.4% vs 16.6%; p<0.01) during the study period. In multivariable regression analyses, non-English, non-French speakers had lower risks of ED visits (adjusted hazard ratio [aHR] 0.91, 95% CI 0.88 to 0.94), hospitalisations (aHR 0.94, 95% CI 0.90 to 0.98) and death (aHR 0.87, 95% CI 0.82 to 0.93) when they received language-concordant primary care. For francophones, the risk of experiencing an ED visit, a hospitalisation or death was not impacted by the language of their family physician.Conclusions Patient–family physician language concordance is associated with a lower risk of adverse outcomes in non-English and non-French speakers. Optimising the delivery of language-concordant care could potentially result in significant decreases in the use of acute healthcare services and mortality at the population level.https://bmjpublichealth.bmj.com/content/2/1/e000762.full |
| spellingShingle | Claire Kendall Sharon Johnston Michael Reaume Peter Tanuseputro Michael Pugliese Douglas Manuel Denis Prud'homme Manish Sood Ricardo Batista Ewa Sucha Rhiannon Roberts Emily Rhodes Emily Seale Lise Bjerre Louise Bouchard Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada BMJ Public Health |
| title | Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada |
| title_full | Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada |
| title_fullStr | Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada |
| title_full_unstemmed | Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada |
| title_short | Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada |
| title_sort | impact of patient family physician language concordance on healthcare utilisation and mortality a retrospective cohort study of home care recipients in ontario canada |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000762.full |
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