Rationale:
Understanding social and clinical characteristics Spanish-speaking Hispanic persons with epilepsy (HPWE) can improve treatment compliance and outcomes. This study’s first objective was to characterize HPWEs and English-speaking persons with epilepsy (EPWEs) on treatments, treatment compliance and socioeconomic features and to subsequently examined treatment compliance in HPWEs assigned to a Spanish-speaking physician.
Methods:
In this retrospective study 104 Spanish-speaking HPWEs (53 men, 51 women) were compared to 100 English-speaking PWEs (46 men, 54 women) (1999 to 2024). Demographic (age, gender, health insurance [uninsured, government funded, private]) and clinical (seizure frequency, anti-seizure medications [ASM], tests, medical encounters, patient compliance) data was collected. Patient compliance was calculated as percentage of kept appointments and percentage of no shows over total number of appointments. Socioeconomic status was calculated utilizing the Neighborhood Atlas website to identify Area Deprivation Indices (ADI) ranging from 0-100 (100 = highest level of "disadvantage"). Subsequent analysis was conducted on the Spanish-speaking sample alone, comparing those who were assigned to a Spanish-speaking physician to those who were not.
Results:
Demographically, the samples were comparable in gender, age, education, and employment/student versus unoccupied status. Clinically, the samples did not differ on seizure frequency but the HPWEs experienced epilepsy for longer than EPWEs. The two patient groups did not differ significantly on whether they were being prescribed generic or brand ASMs, the numbers and types of tests and medical encounters they were provided. Regarding socio-economic status, HPWEs had a higher level of disadvantage than EPWEs and more HPWEs had no insurance or had health insurance from a government source as compared to EPWEs. The HPWEs sample had a significantly lower number of kept appointments versus the total number of appointments made in their history with the practice compared to EPWEs. The two groups did not differ on total number of no-shows to scheduled appointments (see Table 1)
However, Spanish speaking patients assigned to physicians who were Spanish speaking, had significantly lower numbers of no-shows and the duration of their treatment at the practice in years was longer than for Spanish-speaking patients assigned to English-speaking physicians (Table 2).
Conclusions:
The samples were comparable on most demographic variables other than on “disadvantage” rates and health insurance. Despite this, the groups did not differ on access to treatment, types of medical tests or on generic versus brand name medication. However, HPWEs had a lower percentage of kept appointments. Our findings suggest potential benefits of assigning HPWEs to a physician who is fluent in Spanish; HPWEs in this condition had significantly less no-shows and longer treatment duration. In sum, Spanish-speaking PWEs were facing notable socio-economic challenges but were receiving comparable medical care and seemed to be more compliant with care if treated by a Spanish-speaking physician.Funding: None