This study examined whether lack of a common language between a primary care physician and a minority patient is a significant obstacle to delivery of coordinated primary care – specifically outpatient asthma care. The hypothesis tested was that language concordance would be associated with improved compliance and decreased emergency room use by asthmatic patients followed in a faculty group practice.

The study population consisted of adult Spanish-Speaking patients with asthma seen in the Associates in Internal Medicine (AIM) of Presbyterian Hospital in NYC (where 34% of the residents are Hispanic) from July 1979 to March 1987. Patient compliance was measured by the serum levels of theophylline, as well as by the number of scheduled the patient did not miss. Emergency room visits and hospital admissions for asthma were counted and used as measures of medical outcome. Sixty-five patients and physicians were fluent in Spanish (language concordant) and 31 patients had physicians spoke little or no Spanish (language discordant).

In a multivariate analysis, taking into account varying lengths of follow-up time, the patients in the language discordant group were slightly more likely to be non-compliant with their medication, miss an appointment, and have at least one emergency room visit. Patients with eight or more office visits and language discordant physicians were 3.24 times more likely than patients with language concordant physicians to be noncompliant with medication (P=.08) and were 3.06 times more likely than patients in the language concordant group to miss an appointment (P=.01). When disease severity was taken into account, the rate ratios of appointment keeping and medication compliance for patients with language discordant physicians remained unchanged. Finally, the results of this study suggest that the effect of language concordance may be stronger when there is a stable continuous relationship between physician and patient.

Though this study does not directly address the issue of disparities in treatment, the study does emphasize the significant effect of physician and patient relationship in attaining optimal care, specifically the effect of satisfactory patient and physician communication.