This is how a doctor’s visit should go. A patient goes into the exam room and, according to Grace Ting, director of health equity and cultural and linguistic programs at Anthem Blue Cross & Blue Shield of Indiana, says something like this: “Dr. Jones, I’m here to see you about a pain in my arm. I tend to feel it mostly at night, often after I lift heavy things, and it feels like a stinging sensation that travels up and down my arm. But it really doesn’t spread anywhere else. The pain is excruciating, and I can hardly move when it happens.”
Ting adds, “I just delivered that in less than 15 seconds.”
Unfortunately, for too many members of minority groups, the right questions go unasked and descriptions of ailments go unvoiced. In response, the insurer in March launched a Web-based course called Guide Patients to Better Health Care.
The 2001 Commonwealth Fund Health Care Quality Survey showed that minority communities as a whole have had difficulty navigating the American health care system. “The study showed that 1 in 4 African-Americans feel that they did not receive good health care from their physicians, compared to 1 in 3 Latino Americans,” says Ting. “It’s only 16 percent of patients overall that feel this way.”
The insurer wanted to close the gap through better communication. “Of course we thought about a Web site, or even a booklet, geared to the patient. Then we thought that that’s not the best way to teach communication skills.”
Teaching the teachers
Instead, the insurer thought it better to teach community health workers and health educators how to teach better communication skills to patients.
By health educators, Ting means nurses, certified patient educators, patient navigators, patient advocates, community health workers, and promotores del salud who “conduct their education primarily in Spanish. They may be clinicians but they are also often lay workers, trained by their sponsor organizations to communicate their specific health education messages, things like the importance of mammogram screenings. Promotores are a very common concept in Hispanic communities.”
Ting says that there are various resources for training health care professionals on cultural competence and cross-cultural communication skills, but there are few to no resources that provide similar training to help patients, the medical consumers.
“No course like this seemed to exist,” says Ting. So the insurer invented one.
“It took the better part of a year talking to community health workers, health educators,” says Ting. People trained in the course will, it is hoped, help patients to ask questions to fully understand their medical conditions and treatment instructions and help them to share personal challenges in adhering to recommended treatment.
For example, patients who use open-ended questions with their doctor may get more ?information than if they asked yes/no questions.
It cost the insurer about $75,000 to launch the program, and enrollment is not limited to Anthem employees and/or contractors, but promoted to community health organizers as a public service resource. “Health care disparities are so prevalent that we wanted to make this resource available to the public as soon as possible,” says Ting.