Science Daily — An analysis of Milwaukee County pharmacies shows that about half don’t provide prescription labels and instructions in languages other than English, and almost two-thirds are unable to communicate to patients who don’t speak English.

The study, included in the upcoming edition of Pediatrics, is unusual in that its lead author is a Medical College of Wisconsin 4th-year medical student. Michael Bradshaw worked with statistician Sandra Tomany-Korman under the direction of Glenn Flores, M. D., professor of pediatrics.

“Language barriers can have major adverse consequences in health care, but little is known about whether pharmacies provide adequate care to the 23 million Americans who have limited English proficiency (LEP). This is the first study to evaluate pharmacies’ ability to provide non-English-language prescription labels, information packets and verbal communication, and assess pharmacies’ satisfaction with communication with their patients,” according to Bradshaw.

Bradshaw and Tomany-Korman contacted pharmacists or pharmacy technicians at 175 Milwaukee County pharmacies, including those embedded within larger stores such as in supermarkets or retail stores. Some 128 pharmacies (73 percent) responded to the survey, and many indicated that they are with their communication with LEP patients.

“Our research findings suggest that many pharmacies may not provide adequate services to LEP patients, thereby limiting appropriate access to health care and increasing the risk of compromised patient safety,” says Bradshaw.

The survey indicated that one in nine pharmacies that communicate verbally use patients’ family members or friends to interpret, which actually increases the risk of communication errors and resulting medical errors and injury.

The study was able to identify “model” pharmacies that do have effective ways to communicate with LEP patients by hiring bilingual staff, using computer translating programs and telephone interpreting services. Previous studies have documented that verbal counseling by pharmacists improves patient outcomes and is associated with greater patient satisfaction.

Realistically, however, the study may underestimate the problem, according to Bradshaw. About 16 percent of Milwaukee County residents speak a language other than English at home and seven percent have limited English proficiency, but the pharmacists reported a median of five percent of their patients speaking a language other than English at home and a median of three percent having LEP.

There are three potential reasons for the gap:

• Pharmacists may underestimate the proportions of their patients who have LEP.
• Family members who pick up the prescriptions may be the English-proficient members of households, and pharmacists, therefore, may not have direct contact with many of their patients with LEP.
• Patients with LEP get fewer prescriptions because they are more likely to have impaired access, no health insurance, or better health status.

“Either of the first two possibilities suggests that the problems documented in this study are more serious, because pharmacists are only aware of the ‘tip of the iceberg’ of language barriers among their patients. For example, if the pharmacist is not aware that many patients have LEP, then he or she might not even bother to print non-English-language labels or consider having translated information packets,” according to Bradshaw.

Bradshaw suggests that pharmacies and prescription drug plans might want to consider their potential liability for harm to patients who their prescriptions. He also encourages clinics to alert pharmacies that the patient may not understand English. One final is for governments to develop better standards of care for patients with LEP and improve access to bilingual/ multilingual materials.

The research was funded through a grant from the National Heart, Lung, and Blood Institute and conducted in conjunction with the Center for the Advancement of Underserved Children, a joint program of the Medical College and Children’s Hospital, and the College’s department of population health.

Note: This story has been adapted from a news release issued by Medical College of Wisconsin.

Science Daily — Due to limited federal and state funding for vaccines, underinsured children in the United States are at risk for not getting needed vaccines, according to a new study published in the Journal of the American Medical Association.

The study, led by Harvard Medical School and Children’s Hospital Boston Assistant Professor Grace Lee, found that many underinsured children are unable to receive publicly purchased vaccines in either the private or public sector. The authors state, “The most commonly cited barriers to in underinsured children were lack of sufficient federal and state funding to purchase vaccines.”

“Childhood immunization is ranked as one of the most important preventive health services we can offer,” says Dr. Lee, who is a member of the Department of Ambulatory Care and Prevention at the medical school and Harvard Pilgrim Health Care. “Due to the increased cost of recently recommended vaccines and the lack of available funding, many states have been forced to adopt more restrictive policies for the provision of publicly purchased vaccines. children, who used to be able to rely on public health clinics as a safety net in the past, are now at risk of not getting immunized for serious childhood illnesses.”

Childhood vaccines are funded by a patchwork of public and private sources. While some private health insurance plans cover recommended vaccines for children, an increasing number of plans require patients to pay out of pocket for many of these vaccines. However, children who are either uninsured or publicly insured through Medicaid can receive vaccines through the federal entitlement program Vaccines for Children Program (VFC).

Declines in funding coupled with increases in the number and cost of vaccines has put underinsured children at risk for not receiving important vaccines. For example, in one part of this two-phased study, immunization program managers from 48 U.S. states were interviewed. The researchers found that in the private sector, 30 states were unable to provide meningococcal conjugate vaccine to underinsured children, and 24 states could not provide conjugate vaccine. In the public sector, those numbers were 17 and 8, .

Put another way, roughly 2.3 million U.S. children could not receive publicly purchased meningococcal conjugate vaccine in the private sector, and 1.2 million children could not receive this vaccine even if they were referred to public sector clinics.

“Studies suggest that many private clinicians refer underinsured children to public health clinics for vaccination,” says Tracy Lieu, MD, senior author on the study and also a professor at the Department of Ambulatory Care and Prevention. “Unfortunately, a growing number of states no longer provide the most expensive vaccines to these children. The problem may become worse since the trend in private health insurance is to shift to higher deductible plans and in many cases vaccines may not be covered unless the deductible is reached. This could put children from economically vulnerable families at risk of not getting vaccinated.”

According to Dr. Lee, many survey participants voiced concern about their inability to provide immunizations to underinsured children. In fact, since 2004, 10 states have revised their policies in order to restrict underinsured children’s access to select new vaccines.

Lee warns that the situation is creating significant ethical dilemmas for public health clinicians who are being forced to turn these children away or ask families to pay for needed vaccinations.

“Despite the ability of vaccines to prevent illness and death, our current public safety net for these services is under considerable strain,” says Lee. “Strategies are needed to enhance immunization benefits for underinsured children in private health plans and to support the public sector safety net in order to ensure the protection of this vulnerable group of children.”

This study was funded by the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.

Citation: The Journal of the American Medical Association, Vol. 298 No. 6, August 8, 2007 “Emerging Gaps in Vaccine Financing for Underinsured Children in the U.S.” Grace M. Lee, MD MPH(1,2), Jeanne M. Santoli, MD(3), Claire Hannan, MPH(4), Mark L. Messonier, PhD(3), James E. Sabin, MD(1), Donna Rusinak(1), Charlene Gay(1), Susan M. Lett, MD MPH(5), and Tracy A. Lieu, MD MPH1,(6)

1-Department of Ambulatory Care and Prevention, Harvard Medical School & Harvard Pilgrim Health Care 2-Division of Infectious Diseases, Children’s Hospital Boston 3-National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention 4-Association of Immunization Managers 5-Massachusetts Department of Public Health 6-Division of General Pediatrics, Children’s Hospital Boston

Note: This story has been adapted from a news release issued by Harvard Medical School.

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