Despite widespread capacity to provide prescription medication labels in languages other than English, few New York City pharmacies do so and as a result, limited-English patients face serious risk of medication error, according to a study by The New York Academy of Medicine presented at the annual meeting of the Society for General Internal Medicine (SGIM) in Toronto, Ontario.
"Imagine, as an English speaker, picking up a prescription with a label in Chinese--you have no idea what it says. Many New York immigrants face such high-risk gaps in our health care services when presented with a medication bottle in English," said Linda Weiss, Ph.D, senior research associate at The New York Academy of Medicine and lead author of the study. "New York City pharmacies would engage in good health and business practices by providing labels and health counseling in languages their patients understand."
Weiss notes that existing laws require all healthcare providers who receive federal funds to offer language services to limited English proficient (LEP) patients. To date, those laws have been applied at hospitals, clinics, nursing homes and Medicaid agencies. However, because many pharmacy customers use Medicare and Medicaid to purchase prescription drugs, Weiss and her coauthors are examining in ongoing studies if these language requirements also extend to pharmacies.
For this study, the investigators randomly selected 200 pharmacies from the 2,186 licensed pharmacies in New York City in 2006. Participating pharmacies included independent drugstores, chains, and outpatient hospital and clinic pharmacies. They found that while 88 percent of surveyed New York City pharmacists reported serving LEP customers daily, only 34 percent reported translating labels daily, despite 80 percent reporting the ability to do so. Another 26 percent never translate labels.
New York City is home to 130 languages and 8.2 million people, including 2.9 million foreign-born residents. An estimated one of every four adult New Yorkers cannot speak or read English well and 46 percent of the city's population speaks a language other than English at home.
"Considering the importance of taking medication as prescribed, everyone deserves to have their medication instructions in a language they can understand," said co-author Olveen Carrasquillo, M.D., M.P.H., a Spanish-speaking physician with Columbia University's Center for the Health of Urban Minorities, who discussed the data in an oral presentation at SIGM. "If pharmacies don't have multi-lingual staff, then label translation software is widely available. This is a simple, feasible, and low-cost initial step to help patients."
Of pharmacists surveyed, 77 percent reported that they can print labels in Spanish, and a smaller percent (12 percent) can print in Chinese, Russian or other languages. Some 52 percent reported they could provide translated patient information sheets.
Pharmacists cited a number of barriers to improved language access, including the need for additional translation tools (24 percent) and bilingual personnel (20 percent). A small number (5 percent) cited legal concerns. Specifically, they fear being held liable if they print medication information in a language that they don't understand and fail to spot a flawed translation. Others cited time (7 percent) and cost (7 percent) constraints.
A number of pharmacists said they prefer to translate verbally, rather than via printed labels, because they feel it is more personal. However, study authors found that verbal information may be provided by someone without adequate language skills or not qualified to do so. For example, although 75 percent of the pharmacies had Spanish-speaking staff, less than a quarter (22 percent) of pharmacies had Spanish-speaking pharmacists or pharmacy interns, who are legally qualified to provide medication counseling in New York State.
Among the pharmacists who do provide translated labels and pamphlets, 54 percent indicated they did so when noticing a customer struggling with English, and 33 percent did so at a customer's request. However, authors found more than 80 percent of pharmacies surveyed lacked systematic methods for identifying customers, linguistic needs and for informing them of translation capabilities. Fewer than 10 percent of pharmacies reported posted signs to inform customers that translated labels are available.