Low-income African American patients have experienced unequal and discriminatory treatment, which can result in a cultural mistrust of providers; yet, providers in this study were able to engender high trust and satisfaction among these respondents. Still, the sociocultural effects of race concordance require further exploration to better understand the impact on trust in the patient-provider relationship. Finally, the high levels of trust in the NMC may offer a promising solution to the health disparities of African Americans; yet, more research is needed.
Coumadin (warfarin) is an oral anticoagulant used to prevent blood clots in conditions such as atrial fibrillations, stroke, and deep vein thrombosis. Coumadin is the second most common drug-after insulin-implicated in emergency room visits for adverse drug reactions. 1 These adverse reactions can range from minor complications (bleeding from gums, blood in urine, bloody or dark stool, nosebleed) to systemic complications resulting in life-threatening interactions that can cause severe, possibly fatal bleeding. The primary high-risk factor associated with Coumadin is bleeding related to high intensity of the international normalized ratio (INR > 4.0) or to the patients' age (65 years and older). The risk factors make patient knowledge, medication adherence, and the ability to safely manage medication administration critical to maintaining therapeutic anticoagulation balance. In response to this concern, a 20-item measure titled the Knowledge Information Profile-Coumadin (KIP-C20) was developed by the study's principal investigator (PI) to assess patient knowledge of Coumadin. Instrument development began with a search of the literature that included actions, side effects, diet, and self-care medication management and current treatment modalities of Coumadin. The purpose of this research was to examine the reliability and construct validity of the KIP-C20 in a large sample (N = 192) of outpatients recruited from pharmacist-directed anticoagulation clinics and to address the following questions: 1. What is the reliability of the KIP-C20 in this sample of patients? 548594P MTXXX10.
African Americans bear a disproportionate burden of hypertension. A causal-modeling design, using Donabedian's Quality Framework, tested hypothesized relationships among structure, process, and outcome variables to assess quality of care provided to this population. Structural assessment revealed that administrative and staff organization affected patients' trust in their provider and satisfaction with their care. Interpersonal process factors of racism, cultural mistrust, and trust in providers had a significant effect on satisfaction, and perceived racism had a negative effect on blood pressure (BP). Poorer quality in technical processes of care was associated with higher BP. Findings support the utility of Donabedian's framework for assessing quality of care in a disease-specific population.
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