The effect of initiatives to overcome language barriers and improve attendance: A cross- sectional analysis of adherence in an inner city chronic pain clinic

Language barriers can prevent pain physicians and patients from forming meaningful rapport and drive health care disparities. Non-adherence with scheduled pain clinic appointments deprives patients with chronic pain of needed specialist care. Objective. We evaluated the benefit of comprehensive initiatives to overcome language barriers to improve patient adherence with initial scheduled chronic pain clinic appointments. Design. After implementation of our initiative, we performed a retrospective cross-sectional analysis and fit logistic regression models to investigate the association between demographic factors and adherence. Setting. We collected retrospective data from an observational cohort with a scheduled appointment at the adult inner-city underserved outpatient Pain Center at Montefiore Medical Center, Bronx, New York. Patients. Between March 2012 and March 2014, 14,459 appointments were scheduled; 3,035 of these appointments represented initial first visits; patients had a mean age of 53 years; 15% were predominantly Spanish-speaking, 65% were female. Interventions. Our initiative to overcome language barriers in our pain clinic included appointment reminders in the patient's preferred language, Spanish-speaking staff, and unified locations with equitable access. Outcome Measures. Our dependent variable was adherence with a first scheduled pain clinic appointment. Results. We found that after implementation of our initiative, speaking Spanish was now statistically significantly associated with higher rates of adherence with appointments (Odds Ratio 1.32, 95% confidence interval [1.06-1.64]). Conclusions. We infer from our results that coordinated initiatives to overcome language barriers can be beneficial in improving appointment adherence and access to care by enhancing rapport and communication between pain physicians and their patients. Perspective. The results of this retrospective crosssectional analysis of patients' adherence with scheduled appointments in an inner-city chronic pain clinic suggests that targeted initiatives including a pre-clinic reminder phone call in the patient's own language may help to overcome language barriers and improve access to care.