Objectives. We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients.Methods. We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed.Results. Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism...

The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

Predictors of medication adherence in inflammatory bowel disease.

Reframing professional boundaries in healthcare: A systematic review of facilitators and barriers to task reallocation from the domain of medicine to the nursing domain

Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults. We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition- and patient-related factors. The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis. A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further.

https://erj.ersjournals.com/content/erj/45/4/994.full.pdf

Asthma inhaler adherence determinants in adults: systematic review of observational data.

Multilevel interventions are those that affect at least two levels of influence—for example, the patient and the health care provider. They can be experimental designs or natural experiments caused...

/pdf/multilevel-interventions-to-address-health-disparities-show-tynckuuebo.pdf

Multilevel Interventions To Address Health Disparities Show Promise In Improving Population Health

Purpose: To explore asthma symptom perception and the relationship between asthma symptom perception and adherence to asthma treatment.



Design: Adult patients (N=120) of asthma/allergy specialty clinics, taking Advair® as a controller medication, were enrolled in this cross-sectional descriptive study.



Methods: Ninety-seven participants completed 4 weeks of daily diaries to assess subjective symptom perception and measured peak expiratory flow rates (PEFR), both done twice daily. Individual perceptual accuracy scores (PAS) were determined by correlating the subjective symptom perception scores with the PEFRs. Measures included demographic variables, illness identity (personal control and treatment control, consequences, and timeline-cyclical subscales of the IPQ-R), asthma severity (FEV1 percentage) and a single-item indicator of perceived asthma severity. Adherence was measured by the Medication Adherence Report Scale (MARS) and by an Advair® dose count (percentage of doses taken as prescribed).



Findings: Independent t tests comparing adherence rates of good versus poor perceivers were not significant, using either the percentage Advair® dose count or the MARS. Multiple regression analyses showed that years with asthma, illness identity, and peak flow variability were all significant explanatory variables for perceptual accuracy.



Conclusion: Peak flow variability adds complexity to the relationship between perceptual accuracy and adherence that warrants further investigation.

Symptom perception and adherence to asthma controller medications.

Does Systems Thinking Improve the Perception of Safety Culture and Patient Safety

Objective The aim of this study was to determine the effectiveness of the nurse-run annual wellness visit (AWV) in improving adherence to cancer screening recommendations for colonoscopies and/or mammograms. Background The Affordable Health Care Act provides Medicare beneficiaries access to AWVs. Nurse-run AWVs offer individualized education, reinforce health screening recommendations, and may enhance the patients' intent to complete the screenings. Methods A nonexperimental comparative study was conducted using data collected from chart audits comparing patients who only attended the AWV, patients who attended the AWV linked with a physician visit, and patients who have not attended an AWV. Results Patients who attended the AWV showed greater adherence to mammogram completion regardless of the link to the physician follow-up visit. Differences in adherence to colonoscopy recommendations were not significant, likely because of the low number of colonoscopies reported. Conclusions Nurse-run AWV clinics are associated with adherence to mammograms and show promise of increasing colonoscopy compliance.

The Affordable Health Care Act annual wellness visits: the effectiveness of a nurse-run clinic in promoting adherence to mammogram and colonoscopy recommendations.

Purpose: Discrepancy in quality of health care for patients with diverse backgrounds contributes to health outcome disparities. BSN students reveal surprise regarding the presence of health care disparities. Critical social theory guided this study. The psychometric properties of the Perception of Prejudice in Health Care Scale–Modified (PPHC-M) were evaluated, and the relationship between perceived discrimination in health care delivery and cultural sensitivity awareness was explored. Design: A descriptive, cross-sectional survey of 146 Midwest BSN students was conducted using Cultural Competence Assessment (CCA), PPHC-M, and the Marlowe–Crowne Social Desirability Scale. Results: PPHC-M demonstrated reliability (α = .781.) Cronbach’s alphas for General Perception of Prejudice (GPP) and Personal Experience of Prejudice (PEP) were .759 and .756, respectively. Construct validity was supported by contrasted groups. The PPHC was not significantly correlated with the CCA scores. Discussion/Conclusion: PPHC-M s...

http://journals.sagepub.com/doi/pdf/10.1177/1043659611404430

Psychometric evaluation of the perceived prejudice in health care scale-modified (PPHC-M) among baccalaureate student nurses.

PURPOSE:

To provide a summary analysis of five case reports describing the challenges and strategies of nurse practi-tioners' (NPs') first-year experiences on initiating an effective role in a nursing facility practice.



DATA SOURCES:

Original qualitative research analyzing written journals of five NPs and written notes from two loosely struc-tured group discussions among project participants.



CONCLUSIONS:

Two broad themes emerged: Figuring it Out and Responding/Getting a Handle on Things. Common sense and good resources were identified as critical.



IMPLICATIONS FOR PRACTICE:

Strategies to promote ease of role transition are essential for NPs in the nursing facility. Further, in addition to a focus on care of frail older adults, emphasis on the culture of and strategies for nursing facility visits, ethical issues, and ethical decision making are important components of NP educational programs.

Ruth Ohm

Papers

Symptom perception and adherence to asthma controller medications.

Does Systems Thinking Improve the Perception of Safety Culture and Patient Safety

The Affordable Health Care Act annual wellness visits: the effectiveness of a nurse-run clinic in promoting adherence to mammogram and colonoscopy recommendations.

Psychometric evaluation of the perceived prejudice in health care scale-modified (PPHC-M) among baccalaureate student nurses.

Challenges and strategies for initiating a nursing facility practice