Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare.

BACKGROUND: The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. METHODS: Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. RESULTS: 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. CONCLUSIONS: Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.

The migration-related language barrier and professional interpreter use in primary health care in Switzerland.

BACKGROUND: With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study. METHODS: Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use. RESULTS: More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by "using gestures" (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified. CONCLUSION: Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.

[Continuity of care from pediatrician to general practitioner in Switzerland : a practical approach]. / Du pédiatre au généraliste: apporter une continuité aux soins de premier recours de l'enfance à l'âge adulte.

The transition from a pediatrician to a general practitioner builds on a strong relationship with the pediatrician. Informed consent and decision making in children and adolescents are greatly improved by a trustful relationship with healthcare providers. In Switzerland, minors can access their medical file without parental consent if considered competent. Electronic files can be helpful but may lead to breeches in confidentiality : transmission of data concerning the family or parent's health status not relevant for the adolescent's medical follow-up, parental access to the medical files. A simple transmission file can be given to the adolescent at the end of pediatric follow up. Visits to mark the end of the pediatric follow-up and the beginning of the GP follow-up should be systematically offered to young people with special needs.

La relation de confiance avec le pédiatre favorise la capacité des enfants et adolescents à prendre des décisions éclairées pour leur santé et représente un fondement essentiel pour la relation avec les soignants à l'âge adulte. Le cadre médico-légal suisse autorise un mineur capable de discernement à disposer seul de son dossier médical. Le dossier électronique facilite la transmission des données mais peut conduire à des ruptures de confidentialité : informations sur l'état de santé des parents ou sur la famille non pertinentes pour le suivi du jeune, accès des parents au dossier. Une simple fiche de transfert peut être remise au jeune à la fin du suivi pédiatrique. Pour les jeunes avec des besoins spéciaux, une visite de fin de suivi pédiatrique et une autre de début de suivi chez le généraliste devraient être systématiquement proposées.