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Patients who need language interpretation less likely to initially choose a video visit

Kaiser Permanente research shows that once patients try talking to a clinician by video they will probably do it again


Patients with limited English proficiency who need a language interpreter for a telemedicine visit were less likely to choose a video visit for their first time than patients who did not need an interpreter, according to Kaiser Permanente research published Nov. 4 in JAMA Network Open.

The study examined 995,352 primary care phone and video visits scheduled by 642,370 patients between March and October 2020 on the Kaiser Permanente Northern California (KPNC) website.

The authors found that among patients who hadn’t used a video visit before, 29% of those who needed an interpreter chose video over telephone, compared with 36% of those who didn’t need interpreter services. But after patients had their first video visit, there was no significant difference in ongoing choice of video visits (47% needing an interpreter vs. 49% who did not).

Loretta Hsueh, PhD, research fellow, Division of Research.

Study lead author Loretta Hsueh, PhD, a Delivery Science Fellow at the Kaiser Permanente Division of Research, explained the findings. Hsueh studies health care disparities and developed this research along with DOR Research Scientist Mary Reed, DrPH.

Why did you study how people who need language interpretation use video visits?

Hsueh: There was a dramatic increase in the use of video visits by Kaiser Permanente members after the COVID-19 pandemic began, and we wanted to find out how people with limited English proficiency were navigating that change. Telemedicine visits include conversations with a clinician both by telephone and by video. There are advantages to video, particularly for people who use interpretation services, because they can show the clinician a rash or bump, and can also see the doctor use nonverbal cues or gestures, which can be important communication factors for people who do not share a language.

What did you find out from this analysis and why is it important?

Hsueh: We found that about 2% of the patients requested language interpretation, and most of those who did were either Hispanic/Latino or Asian, and between 18 and 64 years old. About one-fifth were from low socioeconomic neighborhoods.

This study didn’t explain the reasons why this group of people might be less willing to do an initial video visit. It could be they haven’t been explained the value of a video visit, or don’t have easy internet access. But reaching out to these patients in particular to help them get connected, to get them signed up for, and connected to, an initial online session with a clinician seems to pay off in the long run.

The good news from this study is that we found patients both with and without language translation needs were more likely to choose video once they’d already tried it at least once. This tells us once patients try it, they see their value. That first video visit is really important, and we need to make that a good experience.

How do translation services work for online medical visits?

Hsueh: KPNC was an early adopter of telemedicine and initially incorporated language translation using a telephone service, so the interpreter would join by audio on either a telephone or video visit. But in mid-2021, KPNC added a new feature to video visits so that the interpreter could also appear as a video participant, which is potentially a major improvement in the care experience.

What else do you expect to study about how patients use telemedicine?

Hsueh: We have a lot of language diversity among our Northern California members – there are about 100 languages represented in our data set. We are working on research that looks at racial and ethnic differences in access to our website and telemedicine services by patients whose primary language is not English.

The pandemic and the way it rapidly changed how our members access care does complicate our research. At the same time, the increase in people using video visits has been a positive thing for patient care, and Kaiser Permanente was able to keep up with that rapid change. There will also be challenges that go along with that change, and we want to learn how to best serve all of our patients, not just the ones who are already engaged and doing well.



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