title: Emergency physician's perception of cultural and linguistic barriers in immigrant care: results of a multiple-choice questionnaire in a large Italian urban emergency department.
abstract: BACKGROUND
  A poor communication with immigrants can lead to inappropriate use of healthcare services, greater risk of misdiagnosis, and lower compliance with treatment. As precise information about communication between emergency physicians (EPs) and immigrants is lacking, we analyzed difficulties in communicating with immigrants in the emergency department (ED) and their possible associations with demographic data, geographical origin and clinical characteristics.
  
  
  METHODS
  In an ED with approximately 85 000 visits per year, a multiple-choice questionnaire was given to the EPs 4 months after discharge of each immigrant in 2011.
  
  
  RESULTS
  Linguistic comprehension was optimal or partial in the majority of patients. Significant barriers were noted in nearly one fourth of patients, for only half of them compatriots who were able to translate. Linguistic barriers were mainly found in older and sicker patients; they were also frequently seen in patients coming from western Africa and southern Europe. Non-linguistic barriers were perceived by EPs in a minority of patients, more frequently in the elderly and frequent attenders. Factors independently associated with a poor final comprehension led to linguistic barriers, non-linguistic obstacles, the absence of intermediaries, and the presence of patient's fear and hostility. The latter probably is a consequence, not the cause, of a poor comprehension.
  
  
  CONCLUSIONS
  Linguistic and non-linguistic barriers, although quite infrequent, are the main factors that compromise communication with immigrants in the ED, with negative effects especially on elderly and more seriously ill patients as well as on physician satisfaction and appropriateness in using services.
authors.affiliation: Emergency Department, Academic Hospital of Parma, Parma, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Numeroso
authors.affiliation: Emergency Department, Academic Hospital of Parma, Parma, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Benatti
authors.affiliation: Emergency Department, Academic Hospital of Parma, Parma, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pizzigoni
authors.affiliation: Service of Clinical Governance, Academic Hospital of Parma, Parma, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Sartori
authors.affiliation: Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.affiliation: Emergency Department, Academic Hospital of Parma, Parma, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
keywords: Cultural barriers; Emergency department; Immigrants; Linguistic barriers