Bilingual Staff Improve Telehealth Experience in Safety-Net Settings

Bilingual personnel and offering audio-only visits were essential for making telehealth visits more efficient and improving the virtual care experience for patients in community health centers, a new study revealed.

For the study, which was published in SSM - Qualitative Research in Health, researchers conducted in-depth interviews with healthcare workers and patients at two federally qualified health centers that primarily serve Chinese and Latino immigrants. They completed 24 interviews remotely between December 2020 and April 2021.

The interview questions revolved around telemedicine visit experiences, technology, resources and needs, barriers, facilitators, language access, and continued use. Both FQHCs adopted telemedicine in March or April 2020.

Through the interviews, researchers identified several factors that helped facilitate telehealth visits. One was having bilingual personnel.

"We're fortunate because we have many staff members who are bilingual in one of those languages," said a leader from one of the clinics, according to the study. "We're usually able to do direct translation during our clinical encounters."

On the patient side, limited English proficiency was identified as a barrier to telemedicine.

"If you're not proficient in English, it's intimidating to figure out what to download and what the instructions are," an FQHC operations staff member said in an interview, according to the study.

Thus, incentives to expand the availability of bilingual providers who can deliver both cultural- and language-appropriate services should be prioritized in safety-net settings, researchers concluded.

"Doing so can help offset low or lack of reimbursement issues for healthcare organizations that serve patients with [limited English proficiency] and dissuade the use of untrained interpreters (i.e., family members) who may pose safety or privacy concern[s]," they stated.

Another significant facilitator of telehealth was the ability to offer audio-only visits. Several personnel said audio-only visits were easy to implement because the telephone was already used to communicate or follow-up with patients before the COVID-19 pandemic.

"I think it's just a lot easier on phone," said an FQHC manager in the interviews. "There's no connection issues."

Personnel from both FQHCs said audio-only visits occurred at a higher rate than video visits throughout the pandemic.

The results highlight the importance of continued reimbursement for audio-only visits, researchers said.

This conclusion is in line with other research showing the impact of audio-only visits, particularly for ensuring telehealth access among vulnerable populations.

A recent federal report showed that those with government-sponsored insurance, Black individuals, and those older than 65 had higher proportions of audio-only visits as compared to their counterparts.

Further, a study published last November showed that telehealth increased access to care for community health centers patients in New York State, with most patients attending audio-only visits compared to video visits.

As of last November, 18 states had enacted policies that made audio-only telehealth coverage permanent. In the months that followed, Washington and Florida also solidified access to telephone-based care.