Improving Clinic Operations

In Buffalo, several efforts address LEP client needs by helping patients understand and navigate health and the health care system. Dr. Li Lin,⁴ professor of industrial and systems engineering at the University at Buffalo, and his team seek to improve patient health and health care knowledge and access to health care in Buffalo. The team developed a website⁵ to distill health information into accessible language. Temporarily hosted by the Immigrant and Refugee Research Institute⁶ in the UB School of Social Work, the website offers information on basic health and health system knowledge including topics like Medicaid, doctor’s visits, hospitals, health, illnesses, symptoms, etc. Written at an appropriate reading level for most patients, the website is an excellent resource for patients, interpreters, social workers, and providers alike. A forthcoming mobile health app⁷ contains website information as well as a public transportation guide for users to navigate to medical appointments. While the app is currently available in Karen, a language spoken by many refugees from Burma, translation is ongoing and other languages will be available in the future. Illiterate users may access buttons that speak the content to the user in his or her own language. Additionally, the team is limiting the mobile data requirement to ensure use for patients with limited data usage plans.

Health literacy is imperative for patients prescribed important, sometimes life-saving medications. According to Miss Chan Myae Thu³ a community health worker at Neighborhood Health Center Northwest,⁸ refugees commonly order online medications that are unavailable in the United States. Others request them from family who send them overseas. Patients taking medications not prescribed by their doctor, or mixing medications without a pharmacist’s knowledge, can cause serious complications to their health. Pharmacists and providers must create a level of trust with their patients so that they are transparent about their practices, especially those that are culturally preferred.

To begin tackling these issues at both the provider and client level, Dr. Gina M. Prescott,⁹ clinical associate professor of pharmacy practice at UB, and her team developed a medication literacy program¹⁰ in response to concerns about proper understanding and use of medications. Hosted through the UB School of Pharmacy¹¹ and in partnership with ESL schools and the International Institute of Buffalo,¹² the team trained pharmacy students in cultural competency, and students facilitated small-group workshops, communicating how to properly read and understand medication labels, open childproof medications, dose medicine for children, and utilize preventive care services. Workshop participants improved the most in label reading, yet struggled to understand preventive medicine. Barriers to the team’s work were largely due to language. The team had to modify materials for participants who were illiterate and sometimes interpreters spoke a different dialect than the participants.

Sometimes clinic staff lack training in caring for diverse populations. If providers face unique challenges in serving refugee patients, those challenges reflect on the care the patients receive. Dr. Lin’s team is examining the needs and challenges facing the providers in a local clinic. His work will result in an outline of strategic steps clinic staff can take to improve efficiency and patient care. To ensure patients receive the highest level of care, Miss Laura Owczarzak,³ a medical case manager for Catholic Charities,¹³ contacts providers to determine their level of cultural humility before referring her clients. She requests patient paperwork before any appointments so that refugees and case managers can fill out the paperwork together. In doing so, clients will arrive to appointments informed and prepared. Cheryl Brown,¹⁴ Buffalo field representative from the New York State Department of Health, meets with providers who perform refugee health assessments for newly arrived refugees. The assessment monitors important physical or mental health concerns and is the first contact patients make with the health care system in the United States. To ensure clinic staff understand the diverse population they are serving, Ms. Brown organizes safe spaces where they can pose questions related to care for refugee patients. Ut nec lectus eu est sagittis blandit eget id purus.

By improving clinic operations, health care providers improve cost efficiencies and deliver higher quality care. Empowered patients can understand their prognosis and navigate the health system, reducing missed appointments and readmissions.

• Illiteracy creates a barrier for some refugees to appropriately utilize health care and medications. Diverse dialects and cultures often confuse doctors, especially those reliant on language line, a phone-interpreting service. Future programs may benefit from adapting materials for those who cannot read as well as training health care providers how to appropriately work with interpreters and pose questions in culturally informed ways. Partnership with the University at Buffalo’s medication literacy program¹⁰ can be helpful.
• Clinic operations that are lagging can invest time with the University at Buffalo's Department of Industrial and Systems Engineering¹⁵ to identify how to improve operations and thereby patient health¹⁴.

• Medical case managers can screen potential care providers and collaborate with refugee patients before scheduled appointments to ensure all paperwork has been completed.³
• Within the community, patients and health care providers must establish understanding of, and a level of trust with one another to improve clinic operations and thereby patient health. Practitioners who do not feel they have the necessary training to understand diverse population needs should contact experts from the New York State Department of Health,¹⁶ International Institute of Buffalo,¹² or University at Buffalo¹⁷ to access training in cultural competency.