Public Release: 

New medical college study finds limited English proficiency, barrier to safe prescription use

Medical College of Wisconsin

An analysis of Milwaukee County pharmacies shows that about half don't provide prescription labels and instructions in languages other than English, and almost two-thirds are unable to communicate to patients who don't speak English. The study, included in the upcoming edition of Pediatrics, is unusual in that its lead author is a Medical College of Wisconsin 4th-year medical student. Michael Bradshaw worked with statistician Sandra Tomany-Korman under the direction of Glenn Flores, M. D., professor of pediatrics.

"Language barriers can have major adverse consequences in health care, but little is known about whether pharmacies provide adequate care to the 23 million Americans who have limited English proficiency (LEP). This is the first study to evaluate pharmacies' ability to provide non-English-language prescription labels, information packets and verbal communication, and assess pharmacies' satisfaction with communication with their patients," according to Bradshaw. Bradshaw and Tomany-Korman contacted pharmacists or pharmacy technicians at 175 Milwaukee County pharmacies, including those embedded within larger stores such as in supermarkets or retail stores. Some 128 pharmacies (73 percent) responded to the survey, and many indicated that they are dissatisfied with their communication with LEP patients.

"Our research findings suggest that many pharmacies may not provide adequate services to LEP patients, thereby limiting appropriate access to health care and increasing the risk of compromised patient safety," says Bradshaw. The survey indicated that one in nine pharmacies that communicate verbally use patients' family members or friends to interpret, which actually increases the risk of communication errors and resulting medical errors and injury. The study was able to identify "model" pharmacies that do have effective ways to communicate with LEP patients by hiring bilingual staff, using computer translating programs and incorporating telephone interpreting services. Previous studies have documented that verbal counseling by pharmacists improves patient outcomes and is associated with greater patient satisfaction.

Realistically, however, the study may underestimate the problem, according to Bradshaw. About 16 percent of Milwaukee County residents speak a language other than English at home and seven percent have limited English proficiency, but the pharmacists reported a median of five percent of their patients speaking a language other than English at home and a median of three percent having LEP. There are three potential reasons for the gap:

  • Pharmacists may underestimate the proportions of their patients who have LEP.

  • Family members who pick up the prescriptions may be the English-proficient members of households, and pharmacists, therefore, may not have direct contact with many of their patients with LEP.

  • Patients with LEP get fewer prescriptions because they are more likely to have impaired access, no health insurance, or better health status.

"Either of the first two possibilities suggests that the problems documented in this study are more serious, because pharmacists are only aware of the 'tip of the iceberg' of language barriers among their patients. For example, if the pharmacist is not aware that many patients have LEP, then he or she might not even bother to print non-English-language labels or consider having translated information packets," according to Bradshaw.

Bradshaw suggests that pharmacies and prescription drug plans might want to consider their potential liability for harm to patients who misunderstand their prescriptions. He also encourages clinics to alert pharmacies that the patient may not understand English. One final consideration is for governments to develop better standards of care for patients with LEP and improve access to bilingual/ multilingual materials.


The research was funded through a grant from the National Heart, Lung, and Blood Institute and conducted in conjunction with the Center for the Advancement of Underserved Children, a joint program of the Medical College and Children's Hospital, and the College's department of population health.

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