Maichou Lor, PhD, RN; Theresa A. Koleck, PhD, RN; Chee Lee, BS, RN; Zer Moua, BA, RN, and Joan E. Uminski, MS, NP
Published online ahead of print April 29, 2022.
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.