University of Wisconsin–Madison Medical College of Wisconsin

Documentation of Pain Care and Treatment for Limited English Proficiency Minority Patients With Moderate-to-Severe Pain in Primary Care

Maichou Lor, PhD, RN; Theresa A. Koleck, PhD, RN; Chee Lee, BS, RN; Zer Moua, BA, RN, and Joan E. Uminski, PA-C, MMSc

WMJ. 2022;121(2):86-93

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Introduction: There are 25 million individuals in the United States with limited English proficiency (LEP). Language barriers contribute to poorer patient assessment, misdiagnosed and/or delayed treatment, and inadequate understanding of the patient condition or prescribed treatment. LEP also has been shown to result in inadequate pain control, yet there are significant gaps in our knowledge related to pain documentation and pain management in primary care settings. The objective of this study is to describe and compare pain documentation for LEP racial/ethnic minority patients – Hmong-speaking Asian and Spanish-speaking Latinx – to English-speaking White patients with moderate to severe pain at an academic primary care clinic.

Methods: We conducted a retrospective mixed methods electronic health record study of patients age ≥ 18 with a pain score of ≥ 6; preferred language of Hmong, Spanish, or English; and evaluation in a primary care clinic. Abstracted data included characteristics of the provider, patient, interpreter, and pain care process. Descriptive statistics, analysis of variance, and chi-square tests were used. Clinician subjective assessment was analyzed using directed content analysis.

Results: Three hundred forty-two patient visits were included. Pain score distribution differed by patient language and race/ethnic group (P < 0.001), with an average pain score of 7.66 (SD 1.25). Interpreter type varied between the LEP groups (P = 0.009). Pain location was documented in a higher percentage of visits overall (87%) and more frequently for English-speaking White and Spanish-speaking Latinx patient visits than Hmong-speaking Asian visits (P < 0.001). Pain quality, onset, and duration were documented more frequently in LEP patient visits than English-speaking White patient visits (all P < 0.001). While overall opioid prescription rates were low, opioids were prescribed 3 times more frequently to English-speaking White patients than LEP patients (P = 0.002). Approximately 20% of patients were prescribed nonpharmacological treatment.

Conclusion: Pain care process and treatment documentation varied by patient language and race/ethnicity. Future studies could evaluate the impact of pain assessment and treatment documentation on pain outcomes for LEP patients.

Author Affiliations: University of Wisconsin-Madison, School of Nursing, Madison, Wisconsin (Lor, Lee); University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania (Koleck); South Dakota State University, School of Nursing, Brookings, South Dakota (Moua); University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Uminski).
Corresponding Author: Maichou Lor, PhD, RN, 701 Highland Ave, Madison, WI 53705; email; ORCID ID 0000-0001-8451-4364.
Acknowledgments: The authors would like to thank Clark Xu for his support in data extraction and Miroslav Backonja, MD, for his feedback on the pain diagnoses and treatment codes.
Funding/Support: The project described was supported by the Clinical and Translational Science Award (CTSA) program through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS) grant UL1TR002373 and the NIH Nursing Institute of Nursing Research (NINR) grant R00NR017651 and K23NR019289. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Financial Disclosures: None declared.
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