WASHINGTON, May 27 (UPI) -- Scientific evidence has yet to conclusively show cultural-competency training for healthcare workers improves the quality of care for minority patients, but physicians and researchers believe it plays an important role in dealing with diverse patient populations.
Researchers at Johns Hopkins University reported this week there is not enough evidence to conclude cultural-competency training leads to better healthcare for minorities. Their study, published in the journal Academic Medicine, found a lack of consistent analysis and reporting of educational interventions designed to improve the cultural competency of healthcare professionals. They concluded more research was needed to determine the impact culture training has on patient care.
"We do believe that cultural competency training is an important intervention and the quality of evidence may be improved if educators with expertise in curriculum development work with researchers in study design and analysis," said co-lead investigator Dr. Eboni Price, a senior clinical research fellow at The Johns Hopkins University School of Medicine.
Cultural training can include foreign-language classes or lectures on different religious holidays. Price said the training should be required for everyone who interacts with patients in a healthcare setting, from doctors who treat patients to the receptionists who greet them.
An earlier separate report by the Institute of Medicine said cultural training was a key tool in reducing racial disparities in healthcare. The IOM study led to mandatory cultural-competency training for health professionals, and New Jersey last month became the first state to require physicians to undergo such training as a requirement for obtaining a medical license. Arizona, California, Illinois and New York also are considering similar legislation.
The Health and Human Services Agency for Healthcare Research and Quality released a healthcare-disparities report in February that found disparities related to race, ethnicity and socioeconomic status in the U.S. healthcare system. The report said disparities are pervasive in quality of, access to, and type of healthcare for minorities.
Dr. Helen Burstin, AHRQ director of the Center for Primary Care Research, said one challenge in ascertaining whether care has improved is the ability to measure the research data. She said researchers should think about what data they are collecting from doctors and hospitals to be able to better measure quality issues.
She said a marriage of sorts between researchers who measure educational training and those who measure the outcomes of the training would result in better data for analyzing whether culture training was effective.
Price said healthcare organizations also have to be sensitive to their demographic. She suggested that if a clinic is in a neighborhood where patients predominantly speak Spanish, the clinic should provide information in Spanish and have good interpreter services on-hand.
Robert Deposada, president of the Latino Coalition in Washington, said language barriers between doctors and Hispanic patients are a problem, but not the No. 1 problem in Latino healthcare.
"The interesting thing is that (cultural difference) has never popped up as the most significant problem," Deposada said. "The uninsured level among Hispanics and the healthcare costs tend to take priority of the issue. Everybody would agree that language and culture barriers with few doctors understanding those things -- that has been a problem."
Deposada said many Hispanics have diabetes, and having a physician tell them to stop eating rice, tortillas and beans, for example, would be a problem because some Hispanics would rather die than follow such guidelines.
Dr. John C. Nelson, president of the American Medical Association, said breaking down cultural barriers to help establish intimate provider-patient relationships is essential for minorities to receive better healthcare.
Nelson said many medical diagnoses are made from the patient history the doctor has obtained, and if there are culture barriers the doctor would be hindered in making the correct diagnosis. Teaching doctors how to deal with different cultures, he said, will help establish better relationships, and in turn provide better healthcare.
He said establishing good doctor-patient relationships needs to be embedded throughout the medical-school curriculum, with cultural-competency training taught from the beginning. Doctors should also continually brush up on culture training throughout their careers.
"All health professionals have a duty to provide good care to patients so that they feel good about their relationship, trust the medical advice provided and want to show up for their next appointment," said co-lead investigator Dr. Mary Beach, internal-medicine specialist at Johns Hopkins University School of Medicine.
Previous cultural-competency studies have found training improved providers' knowledge of patients' different cultures but did not provide conclusive evidence about improvements in healthcare quality.
For the latest study, the Johns Hopkins team focused on evaluating educational programs in cultural competence to see if they actually affected care. The researchers found most studies reported subjective measures, like self-evaluations of how a provider's attitude or knowledge changed since the training, instead of testing whether the knowledge had really improved.
Price said other research flaws included incomplete descriptions of study participants, as well as how training was implemented. She said anyone trying to replicate the studies would not have enough information on how to implement the programs and would not know if their patients were similar to patients in the earlier studies.
