Communication Barriers and the Clinical Recognition of Diabetic Peripheral Neuropathy in a Diverse Cohort of Adults: The DISTANCE Study.
The purpose of this study was to explore communication barriers as independent predictors and potential mediators of variation in clinical recognition of diabetic peripheral neuropathy (DPN). In this cross-sectional analysis, we estimated the likelihood of having a DPN diagnosis among 4,436 patients with DPN symptoms. We controlled for symptom frequency, demographic and clinical characteristics, and visit frequency using a modified Poisson regression model. We then evaluated 4 communication barriers as independent predictors of clinical documentation and as possible mediators of racial/ethnic differences: difficulty speaking English, not talking to one's doctor about pain, limited health literacy, and reports of suboptimal patient-provider communication. Difficulty speaking English and not talking with one's doctor about pain were independently associated with not having a diagnosis, though limited health literacy and suboptimal patient-provider communication were not. Limited English proficiency partially attenuated, but did not fully explain, racial/ethnic differences in clinical documentation among Chinese, Latino, and Filipino patients. Providers should be encouraged to talk with their patients about DPN symptoms, and health systems should consider enhancing strategies to improve timely clinical recognition of DPN among patients who have difficult speaking English. More work is needed to understand persistent racial/ethnic differences in diagnosis.
a Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
Alyce S
AS
Adams
a Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
Melissa M
MM
Parker
a Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
Howard H
HH
Moffet
b Department of Medicine and Endocrinology , The Permanente Medical Group, Kaiser South San Francisco Medical Center , San Francisco , California , USA.
Marc
M
Jaffe
c Center for Vulnerable Populations , University of California San Francisco, San Francisco General Hospital and Trauma Center , San Francisco , California , USA.|d Division of General Internal Medicine , University of California San Francisco, San Francisco General Hospital and Trauma Center , San Francisco , California , USA.
Dean
D
Schillinger
e University of Michigan School of Medicine , Ann Arbor , Michigan , USA.
Brian
B
Callaghan
e University of Michigan School of Medicine , Ann Arbor , Michigan , USA.
John
J
Piette
f Department of Pediatrics and Center for Health and Community , University of San Francisco , San Francisco , California , USA.
Nancy E
NE
Adler
g Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , Washington , USA.
Amy
A
Bauer
a Division of Research , Kaiser Permanente Northern California , Oakland , California , USA.
Andrew J
AJ
Karter
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations