Proper translation could prevent medical errors

Providing language-appropriate prescription labels could eliminate some of the medical errors responsible for 98,000 deaths each year in the United States, but chain-owned pharmacies were less likely to provide them than small, independent drug stores in a study in a recent issue of the Journal of Health Care for the Poor and Underserved (JHCPU), published by Meharry Medical College.

The study, which examined the availability of Spanish prescription labels in the Bronx, N.Y., found that pharmacies providing them usually relied on a computer program to translate the physician's order from English. Of the 86 percent of pharmacies using computer translations, only one had a Spanish-speaking employee who could check the accuracy of the computer and correct errors. In addition, patients had to specifically request a Spanish label at all the pharmacies, the study found.

During a follow-up visit to one large chain pharmacy, researchers found that the computer could not translate such commonly used terms as "dropperful" or "for thirty days."

Of the 162 pharmacies in the area, 161 participated in the telephone survey. Of the 125 small pharmacies surveyed, 71 percent said they could provide labels translated into Spanish. Of the large-chain pharmacies, 61 percent were able to provide labels in Spanish.

The study was conducted by Iman Sharif, associate professor of clinical pediatrics and associate director of residency training in social pediatrics at the Albert Einstein College of Medicine/Children's Hospital at Montefiore in the Bronx, Sarah Lo, pediatric resident, and Philip Ozuah, professor and interim chair for the Department of Pediatrics.

The researchers said that because the survey involved pharmacies in only one county, their findings cannot be generalized to other areas. They said the findings have several implications. Physicians should advise Spanish-speaking patients to request prescription labels in that language. Physicians also should include that request on the order form. However, the researchers cautioned that the availability of such labels does not mean that the instructions will be easily translated or understood by patients.

The researchers said that further study is needed to determine the adequacy of current computer translations and to determine how to improve them. They also suggested that advocacy groups consider ways to increase the representation of Spanish-speaking pharmacists in underserved areas with large Spanish-speaking populations.

"This study demonstrates how subtly disparities in care can creep into the health care system," said Virginia Brennan, Ph.D., editor of Meharry's JHCPU. "As America's refugee and immigrant population grows, language barriers to care must be addressed.”

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