Culturally Competent Healthcare: Meeting Patients Where They Are

Given the increasingly diverse makeup of the US population, culturally competent care is a popular topic of discussion nowadays among healthcare professionals in addition to physician burnout. Research does show, however, that culturally competent care is truly an important way to improve public health and health outcomes of diverse patients. Cultural competence is the ability of healthcare providers to meet the social, cultural, and linguistic needs of their patients. [Betancourt 2002] It is becoming more and more important as clinicians are increasingly providing care for patients with broad cultural and social backgrounds, which influences their health perspectives. Providing culturally competent care can both improve the quality of care and help to eliminate racial and ethnic health disparities. [Institute of Medicine 2001; Smedley 2002]

The ability to add elements of cultural competence to health care practices and organizations helps to improve the care delivered and the health outcomes of patients. This can be done in a variety of ways. Language barriers have been identified as a barrier for minorities in receiving adequate care and can have an important impact on the health of patients. Spanish-speaking Latinos have been found to be less likely than whites to receive regular care and preventive services, including mammograms and vaccinations. [Fiscella 2002] With 37 million Americans speaking a language other than English, these barriers can have a large effect on public health. The provision of interpreter services can improve both patient satisfaction and outcomes. Language services should extend beyond interpreters for appointments, into both clinical and non-clinical staff, medical billing, and health education materials. Taking health literacy into account when providing care is also an important element in the addressing of cultural barriers. Patients with low health literacy have been found to have poorer health outcomes and higher health care expenditures, so addressing this barrier is an important element. [Berkman 2011] By addressing both language and literacy barriers, health care providers can address specific cultural competencies.

Addressing cultural barriers in the creation of disease management programs and health promotion tools are important elements of providing culturally competent care. A higher proportion of African Americans and Latinos have at least one of seven chronic conditions (asthma, cancer, heart disease, diabetes, high blood pressure, obesity, anxiety or depression), which rank among the costliest medical conditions in the US. [Collins 2002; Druss 2002; Fried 2003] Given the correlation between providing culturally competent care and health outcomes, this area is one that physicians should prioritize.

In order to address the needs of diverse populations, the health care system must meet patients where they live. Transportation is a barrier to healthcare for approximately 3.6 million Americans, with a lack of transportation linked to decreased access to and utilization of healthcare.  Having a usual source of care and a regular doctor have been tied to higher utilization of preventive services and higher rates of diagnosis and treatment of chronic diseases. By locating services in areas that are accessible to the populations they serve, a barrier to providing culturally appropriate care can be removed.

Building in culturally competency into the medical education is also key to creating a healthcare system that serves all patients.  This begins with clinicians educating office staff in the basics of culturally competent care, and continues through the medical education system. Can we a few classes here and there fix the healthcare system? No but the education is necessary especially as it relates to stressing the importance of the relationship between cultural beliefs and behavior and developing skills to improve quality of care to diverse populations. [Betancourt 2005]

It is critical to assure that the care provided to all patients is culturally competent as a method of providing high quality care and to eliminate racial and ethnic disparities and assure equity. Understanding an unpacking our implicit biases is a good start.

Sources:

Berkman ND, Sheridan SL, Donahue KE, et al. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155:97–107.

Betancourt, J. R., Green, A. R., & Carrillo, J. E. 2002. Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund.

Betancourt, JR, et al. Cultural Competence And Health Care Disparities: Key Perspectives And Trends. Health Affairs. 2005 24:2, 499-505.

Collins, K.S., Hughes, D. L., Doty, M. M., Ives, B. L. Edwards, J. N., & Tenney, K. 2002. Diverse communities, common concerns: Assessing health care quality for minority Americans. New York: The Commonwealth Fund.

Druss, B.G., Marcus, S.C., Olfson, M., Pincus, H.A. The most expensive medical conditions in America. Health Affairs. 2002;21:105-111.

Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. Disparities in health care by race, ethnicity and language among the insured: Findings from a national sample. Medical Care. 2002:40(1), 52-59.

Fried, V. M., Prager, K., MacKay, A. P., Xia, H. 2003. Health, United States, 2003: Chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics.

Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academies Press, 2001)

Smedley BD, Stith AY, Nelson AR. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington: National Academies Press, 2002).