Abstract: FR-PO265
Patient Language and Guideline-Concordant Care Among Individuals with CKD in Primary Care
Session Information
- CKD: Clinical, Outcomes, Trials - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Rosenwohl-Mack, Sarah, University of California, San Francisco, San Francisco, California, United States
- Rubinsky, Anna, University of California San Francisco/SFVAMC, San Francisco, California, United States
- Karliner, Leah, University of California, San Francisco, San Francisco, California, United States
- Lopez, Lenny, University of California, San Francisco, San Francisco, California, United States
- Peralta, Carmen A., University of California San Francisco/SFVAMC, San Francisco, California, United States
Background
Patients with a language barrier are at risk for poor communication and inadequate management of chronic conditions. We assessed the quality of Chronic Kidney Disease (CKD) management in primary care for non-English speakers compared to English speakers.
Methods
Using EHR data (2014-2015), we evaluated the association of non-English language preference with guideline-concordant care among adults with CKD in a primary care clinic in San Francisco where interpreters are available. Outcomes included: testing for albuminuria (all) and A1c (patients with diabetes); prescription of ACEi/ARB and statins; BP at goal < 140/90 and A1c<7 (patients with diabetes). We used multivariate modified Poisson regression to estimate relative risks of each outcome.
Results
Among 1,726 patients, mean age was 66 ±10, 26% were Asian, 14% Black and 7% Hispanic. 88% had Medicare and 10% Medicaid. Compared to English speakers, non-English speakers had higher prevalence of comorbidities (cerebrovascular disease, 16% vs. 12%; diabetes, 57% vs. 41%; and hypertension, 89% vs. 81%) and more frequent primary care visits, but similar eGFR (49 vs. 48 ml/min/1.73m2). In unadjusted comparisons, non-English speakers were more likely to be tested for albuminuria and have a prescription for statins, but there were no differences in ACEi/ARB prescription, BP or A1c control. After adjustment, differences were mostly attenuated.
Conclusion
Overall, most guideline measures were sub-optimally met. However, there was consistent care across language preference: in a single clinic with access to professional interpreters, non-English language preference was not associated with differences in guideline-concordant processes of care for CKD.
Rates of Guideline-Concordant Care by Language Preference
| Process of Care | English Speaker (%) | Non-English Preference (%) | Adjusted* RR (95% CI) |
| Testing for albuminuria | 41 | 53 | 1.03 (0.90,1.17) |
| A1c testing in diabetics | 98 | 98 | 0.99 (0.96,1.02) |
| Statin prescription | 66 | 77 | 1.01 (0.94,1.09) |
| ACE/ARB prescription | 72 | 73 | 0.90 (0.82,0.99) |
| BP control | 75 | 74 | 1.05 (0.96,1.14) |
| A1c <7 in diabetics | 77 | 59 | 0.97 (0.75,1.25) |
*Fully adjusted (age, sex, race, insurance type, number of PC visits in the study period, CKD stage, count of comorbid conditions if applicable)
Funding
- NIDDK Support