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Many asthma patients don't understand their doctor

January 22, 2009

  • UCLA Center for Health Policy Research
    ​ Los Angeles - Nearly 90,000 California adults with asthma experience problems understanding their doctors - a barrier that contributes to thousands of unnecessary and frightening emergency room visits each year.

    About 20,000 asthma patients that reported problems understanding their doctor wound up in the emergency department or urgent care facility in 2005, according to a new policy brief by the UCLA Center for Health Policy Research: Many Californians With Asthma Have Problems Understanding Their Doctor.

    That rate of ER/Urgent care visits is 77% higher than for asthma patients without physician communication problems.

    According to the research, adults born outside the U.S., those who have low income and/or low education levels, as well as those covered by public insurance are more likely to experience communication problems with their health care providers.

    "You can't follow doctor's orders if you don't understand your doctor," said Susan H. Babey, co-author of the policy brief. "Because California is so diverse, physicians often do not speak the language of their patients and many cannot provide language assistance services. They may not have translated materials on hand for patients to read. The result is a missed opportunity for preventive care."

    Asthma, a chronic disease that affects three million Californians, causes the airways of the lungs to become inflamed and more sensitive to constriction, making it harder to breathe. Management of asthma requires a strong partnership between doctor and patient to ensure ongoing monitoring, education, use of appropriate medications and control of exposures to environmental triggers.

    Yet among California adults with asthma:
    • Over 237,000 adults with asthma say they do not speak English very well. Among this group, 13% - nearly 31,000 people - experience problems understanding their doctors. This rate is more than three times higher than those who speak English very well or who are native English speakers.
    • 13% of those who have not completed high school report problems understanding their doctors, compared to 6% of high school graduates and only 2-3% of those with at least some college.
    • The percent of poor people with asthma (245,000 California adults) who experienced problems understanding a doctor is more than six times higher than those with the highest incomes (300% the Federal Poverty Level and above).
    • 9% of those covered by Medi-Cal (California's state Medicaid program) are more likely to have problems understanding their doctors than those on employment-based insurance plans (3%). (In California, 350,000 adults with current asthma are covered by Medi-Cal.)
    • The National Asthma Education and Prevention Program recommends that health care providers give all patients with asthma written asthma action plans. However, in California, only 37% of adults with asthma report ever receiving an asthma management plan, and adults who experience problems communicating with their doctors are even less likely to get such a plan.

    "It is essential that health care providers ensure the delivery of culturally relevant and language-appropriate medical care instructions to their patients for the treatment of chronic health conditions," said Robert K. Ross, M.D., president and CEO of The California Endowment. "We can help reduce these health disparities among racial and ethnic populations by improving the diversity of the state's health care workforce, and improving the cultural competence of existing health care providers."

    The research was based upon findings from the Californian Health Interview Survey (CHIS), the nation's largest state health survey.

    The policy brief was supported by The California Endowment.

    About The UCLA Center for Health Policy Research
    One of the nation's leading health policy research centers and the premier source of health-related information on Californians.

    About The California Health Interview Survey (CHIS)
    CHIS is the nation's largest state health survey and one of the largest health surveys in the United States. Visit us at

    About The California Endowment
    The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. For more information, visit The Endowment's Web site at