A logistic regression model on the effect of initiatives to overcome language barriers and
improve attendance in an inner city pain clinic
Michael H. Andreae MD1, Kelly Yan Chen BS1, Robert S. White MD2, Singh Nair MD1, and
Naum Shaparin MD1
1.
2.
Montefiore Medical Center, Department of Anesthesiology, Bronx, NY.
Weil Cornell Medical Center, Department of Anesthesiology, New York, NY
Abstract:
Introduction
Failure of patients to attend a clinic appointment (FA) deprives patients of needed pain consultations
and constitutes a waste of resources. We have shown previously that specifically Spanish, are was
associated with reduced odds of arriving for an inner city chronic pain clinic appointment. We
implemented several strategies to prevent or reduce FA, in particular pre-clinic calls to all patients in
English or Spanish according to the primary language spoken. Our retrospective cohort study tested
the hypothesis that the previously shown association of FA with patient characteristics persists after
implementation of counter measures.
Methods:
We collected retrospective data from an observational cohort of patients at an urban chronic pain
center from March 2012- March 2014. All patients scheduled for an appointment received a preappointment reminder phone call in English and Spanish for Spanish-speakers. We fit logistic
regression models. We included potential confounders selected a priori, such as age, race, and gender.
Results:
Of 3035, 1672 individuals arrived for their clinic appointment (1362 were failed to attend, of which
756 patients cancelled). Our analyses showed that Spanish spoken as a primary language, age, being
white, declining to provide racial identity information, and having commercial insurance were
associated with greater odds of arriving to initial clinic appointment.
Our study suggests that making pre-clinic calls to all patients in English or for Spanish speakers, Our
study is limited in that that we do not know for sure if the Spanish spoken as a primary language
specific phone call drove patients to attend their clinic appointment. Furthermore our findings may
not be generalizable to other settings.
Conclusion
Language barriers prevent physicians and patients to form meaningful relationship leading to FA and
overbooking. Language barriers, specifically Spanish, is associated with increased FA. Our study
suggests that health disparities can be overcome by patient-centered countermeasures.
This publication was supported in part by 5KL2TR001071-03 from the National Center for
Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).