A comparison of general practice encounters with patients from English-speaking and non-English-speaking backgrounds

People from culturally and linguistically diverse backgrounds form an integral part of Australia's social fabric. Data from the 1996 census showed that 27% of Australian residents were born overseas and 15% were born in a non-English-speaking country. Among adults of working age, the proportion of those born in non-English-speaking countries was 22%.1

Understanding the utilisation of primary care, in particular general practice, is considered important in evaluating further demands for health services.2 There is ample evidence from Australian and overseas studies of health differences between ethnic groups, although the picture is complex.3-5 Issues of culture and language may constitute barriers to obtaining adequate healthcare,6 and issues of ethnicity and health are nearly always confounded by socioeconomic factors.3,7 Given these complexities, it cannot be assumed that people from culturally and linguistically diverse backgrounds consult general practitioners for the same purposes as the Australian community as a whole.

Most studies of ethnic differences in primary care have focused on one particular health aspect4,8 — very few have looked at group differences in overall use of healthcare services. There is some limited evidence from the United Kingdom of ethnic differences in consultation rates and the nature of problems managed in general practice.9 However, there have been no recent large-scale studies investigating the overall morbidity profile of culturally and linguistically diverse patients consulting GPs in Australia.

We wished to determine whether encounters in general practice with patients from a non-English-speaking background (NESB) differ from encounters with patients from an English-speaking background (ESB) in terms of the characteristics of the patients, the practices where the encounters took place and the problems managed at the encounters.

In metropolitan practices, NESB patients consulted GPs in a diverse range of general practice settings. GPs who operated solo practices and those who consulted in a language other than English were more likely to have encounters with NESB patients. This confirms that bilingual GPs have an important role in providing healthcare to many NESB patients.6

Our results support previous findings of different morbidity patterns managed in general practice for patients from different language backgrounds.9 Because statistics for encounters do not distinguish between the number of visits by separate patients and the number of return visits by an individual patient, morbidity rates can not be related directly to underlying differences in the prevalence of certain medical problems among NESB and ESB groups. It is also possible that apparent differences in morbidity between the two groups are more a reflection of differing beliefs about what type of problems are appropriate to discuss with a GP.

The higher rates of diabetes management in NESB encounters may reflect the relatively higher population prevalence of self-reported diabetes among Australians who do not speak English at home.14 However, differences in community prevalence do not readily explain the higher rates of hypertension problems discussed in NESB encounters, as self-reported cardiovascular conditions such as hypertension are no higher among NESB than ESB people in the general population.15

Whether mental disorders are any more or less prevalent among the NESB population than the rest of the community is uncertain, as studies have produced conflicting results.2,6,16 It is unclear from our study whether lower rates of psychological problems managed at NESB encounters reflect lower prevalence of these disorders in NESB groups, different beliefs about the appropriateness of raising such issues with GPs, GPs' skill in detecting psychological problems, or other factors. Previous research has suggested that GPs find it more difficult to detect psychological problems in their NESB patients8 — whether this is because NESB patients more often express psychological distress in somatic rather than psychological terms is a matter for debate.8,17

Although census data indicate that nearly 15% of Australians were born in a non-English-speaking country,1 only 7% of encounters with GPs in our study were identified as being with NESB patients. This discrepancy may be partly a matter of definition: in our study, we defined NESB in terms of the primary language spoken at home, while in the census it was defined according to country of birth, so the two categories are not exactly equivalent. Nevertheless, the number of encounters with NESB patients may have been under-reported in our study, as GPs may have omitted to label certain patients as "NESB" if they spoke English well. There has been some variability over time in the proportion of encounters with NESB patients in the BEACH study, possibly due to GP recording practices, as well as to some small changes to the recording form each year.18

Our findings relate to the population of general practice patients. Any extrapolation to the broader Australian population of NESB people should be made with caution. Furthermore, the category "NESB" includes a diverse range of cultures and ethnic identities, and there are limitations in applying the findings from this study to any specific cultural, language or ethnic group. Studies of specific NESB communities are required to explore the extent that the broad differences identified in this study apply to individual groups.