Strong data proves that the most successful medical care is provided in a culturally-sensitive manner by linguistically congruent physicians. In an effort to continue the Department’s mission of making healthcare more accessible for underserved populations, we are introducing Programa de Salud Familiar (PSF) or Family Health Program. Under the leadership of Katherine L. Hughey, M.D., assistant professor, Maricela Castillo MacKenzie, M.D., assistant professor, and Juana Nicoll Capizzano, M.D., assistant professor, PSF will remove a language barrier in healthcare as it provides care and addresses health disparities with cultural understanding.
“Every community needs a healthcare team who is culturally and linguistically appropriate, which will likely improve a patient’s overall experience and clinical outcome. This is one step closer to health equity in the U.S.,” noted Dr. Castillo MacKenzie.
PSF will mirror the Department’s tripartite mission and work for equity and accessibility in patient care, education and research, as well as community outreach endeavors.
Faculty and residents at three of our clinic sites, including the Ypsilanti Health Center (YHC), Briarwood Family Medicine and the Livonia Health Center, will provide care entirely in Spanish. The care team at YHC includes bilingual physician, nursing, medical assistant and clerical staff; PSF plans to offer similar services at all sites. Thanks to strong internal advocacy by members of PSF, Michigan Medicine’s (MM) online patient portal is now available in Spanish and patient education materials will also be provided in Spanish. The team is currently developing an internal referral system so that team members within MM and in the wider community can easily and confidently refer patients for language-concordant and culturally aware primary care and procedures. And, Dr. Hughey noted that they anticipate building a network of bilingual primary care physicians and specialists across MM to promote a connected and holistic approach to patient care.
Drs. Hughey, Castillo MacKenzie, and Capizzano have lofty goals for PSF. In the future they will expand clinical services to provide group visits in Spanish for multiple areas including prenatal care and diabetes prevention. They are working to build a program that supports wrap-around services for patients outside of the typical office visit. “Our team members have expertise in geriatrics, adolescent mental health, cesarean obstetrical deliveries, transgender healthcare, obesity medicine, primary care procedures, and medication-assisted treatment for substance abuse and we are working to expand services in these areas,” shared Dr. Hughey.
The Spanish Language and Community Medicine Residency Track (SLCM), which was highlighted in the last Newsletter, began in 2018 and has successfully matched Spanish-fluent candidates in each of its first three years and interest in the program has grown. SLCM reserves one space per year within the residency program at YHC for a Spanish-speaking resident and has its own curriculum embedded within the general residency curriculum. During the recruitment season of 2018, there were 13 candidates who interviewed for the SLCM track and only three of them were Hispanic. During the interview season of 2020 the number of candidates who interviewed was 25, 11 of whom were Hispanic. The number of applicants almost doubled since we started the track and, more interestingly, the number of Hispanic applicants almost quadrupled,” shared Dr. Castillo MacKenzie who is the faculty lead of SLCM. She also noted that other residency programs have shown interest in this track.
PSF faculty and SLCM residents are also involved at the medical school level. Five faculty members are teachers within the Medical Spanish student elective. SLCM residents also teach Advanced Spanish to medical students as part of their residency curriculum. PSF member, Mikel Llanes, M.D., assistant professor, is the faculty advisor for the Latin American and Native American Medical Association and represents U-M at the National Latino Medical Student Association. And, Dr. Hughey is currently working with Clinica Peruvian American Medical Society in Chincha Alta, Peru, to develop a program where learners at all levels (students, residents and fellows) will be able to do rotations and electives. Lastly, opportunities for all learners are also available at the Hamilton Network in Flint, Mich. through partnerships with PSF member, Timothy Tellez, M.D., lecturer, and Dr. Hughey.
PSF members are involved in many areas of scholarly work with a focus on promoting health equity for Latinx/Hispanic communities. PSF provides a platform for partnerships and collaboration in these efforts. Current projects include:
- A qualitative study examining barriers to contraception use for Latinx/Hispanic patients at YHC; and
- A multi-site study exploring the standardization of medical Spanish education.
Additionally, Dr. Hughey is a steering committee member for Adherence to Medications in Latinx with Depression and/or Anxiety, a community-based participatory research project focused. Dr. Llanes and Laura M. Crespo Albiac, M.D., lecturer, continue a longstanding relationship with Encuesta Buenos Vecinos, another community-based participatory research project that examines health status factors for the Latinx/Hispanic community in Washtenaw county.
A fourth focus of PSF is advocacy and community partnership. Dr. Castillo MacKenzie has long been working towards the goals of improving healthcare for the Latinx/Hispanic community. She has a longstanding relationship with the Mexican Consulate of Detroit and Northern Ohio. Through this she has assisted with the Ventanilla de Salud (Healthy Window) project.
“Ventanilla de Salud is an initiative created by the Mexican government to assist the Mexican community to navigate the healthcare system in the U.S. and provide resources and health education. Among these projects, I’ve coordinated health fairs, provided education to the community, and created a bilingual immunization record,” she noted.
Dr. Llanes leads a program at Ypsilanti High School with Spanish-speaking or English as a second language students that focuses on socio-emotional learning. “Many PSF members attend community health fairs and events to connect with the community and provide health-related information. They also volunteer with U-M’s Migrant Clinic and U-M’s Asylum Collaborative. And, PSF participates in multiple advocacy events with local, state and federal government bodies to promote health equity,” Dr. Hughey said.
“Moving forward a major part of our outreach and advocacy will be focusing on health equity related to COVID-19 and vaccine access for the Hispanic community, which has been disproportionately affected by the pandemic,” added Dr. Castillo MacKenzie, who has led a grassroots effort to share accurate information on COVID-19 and the vaccine on social media and has been interviewed by international Spanish-language media.
Millions of patients struggle with language barriers in navigating health care systems and communicating with their doctors; their clinicians struggle too. Language barriers are associated with lower patient comprehension, satisfaction, and trust in physicians, and often, worse clinical outcomes. For clinicians, language barriers can invoke dread, with visions of wasted time, communication frustration, and increased difficulty in providing high-quality care. And, patient safety can suffer when language barriers impede easy communication. PSF attempts to combat this by providing care and wraparound services in Spanish, building the pipeline of bilingual and bicultural physicians and conducting research addressing health disparities.