患者-家庭医生语言一致性对医疗保健使用率和死亡率的影响:对加拿大安大略省家庭护理对象的回顾性队列研究

Michael Reaume, Ricardo Batista, Ewa Sucha, Michael Pugliese, Rhiannon Roberts, E. Rhodes, Emily Seale, Claire E. Kendall, Lise M. Bjerre, Louise Bouchard, Sharon Johnston, Manish Sood, Denis Prud’homme, Douglas G. Manuel, P. Tanuseputro
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引用次数: 0

摘要

随着世界语言多样性以前所未有的速度持续增长,越来越多的患者将面临在初级医疗环境中遭遇语言障碍的风险。我们试图研究在初级医疗机构中,患者与家庭医生语言的一致性是否与较低的医院医疗使用率和死亡率有关。我们对居住在加拿大安大略省的 497 227 名家庭护理对象进行了一项基于人群的回顾性队列研究。患者的语言来自于家庭护理评估,而医生的语言则来自于安大略内科和外科医生学院。当患者和他们名册上的家庭医生使用一种双方都能听懂的语言时,我们将初级护理定义为语言一致,而将所有其他初级护理定义为语言不一致。与接受语言不一致初级医疗服务的非英语、非法语人士相比,接受语言一致初级医疗服务的患者在研究期间的急诊就诊率较低(53.1% vs 57.5%;p<0.01),住院率较低(35.0% vs 37.6%;p<0.01),死亡率较低(14.4% vs 16.6%;p<0.01)。在多变量回归分析中,非英语、非法语使用者在接受语言一致的初级医疗服务时,其急诊室就诊风险(调整后危险比 [aHR] 0.91,95% CI 0.88 至 0.94)、住院风险(aHR 0.94,95% CI 0.90 至 0.98)和死亡风险(aHR 0.87,95% CI 0.82 至 0.93)均较低。对于讲法语的人来说,急诊室就诊、住院或死亡的风险并不受家庭医生语言的影响。优化提供语言一致的医疗服务有可能显著降低急诊医疗服务的使用率和人口死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of patient–family physician language concordance on healthcare utilisation and mortality: a retrospective cohort study of home care recipients in Ontario, Canada
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.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.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.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.
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