title: Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients.
abstract: BACKGROUND
  Health systems are increasingly implementing remote telephone and Internet refill systems to enhance patient access to medication refills. Remote refill systems may provide an effective approach for improving medication non-adherence, but more research is needed among patients with limited English proficiency with poor access to remote refill systems.
  
  
  OBJECTIVE
  To compare the use of remote medication refill systems among limited-English-proficiency (LEP) and English-proficient (EP) patients with chronic conditions.
  
  
  METHODS
  Cross-sectional survey in six languages/dialects (English, Cantonese, Mandarin, Korean, Vietnamese, and Spanish) of 509 adults with diabetes, hypertension, or hyperlipidemia. Primary study outcomes were self-reported use of 1) Internet refills, 2) telephone refills, and 3) any remote refill system. LEP was measured by patient self-identification of a primary language other than English and a claims record of use of an interpreter. Other measures were age, gender, education, years in the U.S., insurance, health status, chronic conditions, and number of prescribed medications. Analyses included multivariable logistic regression weighted for survey non-response.
  
  
  RESULTS
  Overall, 33.1 % of patients refilled their medications by telephone and 31.6 % by Internet. Among LEP patients (n = 328), 31.5 % refilled by telephone and 21.2 % by Internet, compared with 36.7 % by telephone and 52.7 % by Internet among EP patients (n = 181). Internet refill by language groups were as follows: English (52.7 %), Cantonese (34.9 %), Mandarin (17.4 %), Korean (16.7 %), Vietnamese (24.4 %), and Spanish (12.6 %). Compared to EP patients, LEP patients had lower use of any remote refill system (adjusted odds ratio [AOR] 0.18; p < 0.001), CONCLUSIONS: LEP patients are significantly less likely than EP patients to use any remote medication refill system. Increased reliance on current systems for remote medication refills may increase disparities in health outcomes affecting LEP patients with poor access to telephone and Internet medication refills.
authors: UCLA Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA. gemoreno@mednet.ucla.edu.
authors: Gerardo
authors: G
authors: Moreno
authors: Group Health Research Institute, Seattle, WA, USA.
authors: Elizabeth H
authors: EH
authors: Lin
authors: Group Health Research Institute, Seattle, WA, USA.
authors: Eva
authors: E
authors: Chang
authors: Group Health Research Institute, Seattle, WA, USA.
authors: Ron L
authors: RL
authors: Johnson
authors: Group Health Research Institute, Seattle, WA, USA.
authors: Heidi
authors: H
authors: Berthoud
authors: School of Social Work, University of Washington, Seattle, WA, USA.
authors: Cam C
authors: CC
authors: Solomon
authors: Group Health Research Institute, Seattle, WA, USA.|Center for Health Equity, Diversity and Inclusion, School of Medicine, University of Washington School Medicine, Seattle, WA, USA.
authors: Leo S
authors: LS
authors: Morales
mesh_terms: D000368:Aged; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D019303:Multilingualism; D013689:Telephone / Q000706:statistics & numerical data*
keywords: adherence; disparities; language barriers; minority health; survey research