Different Responses to Social Capital Among Black People and White People: What Racial Differential Item Functioning Reveals for Racial Health Equity.

Social capital has been conceptualized as features of social organization, such as networks, and norms that facilitate coordination and cooperation for mutual benefit. Because of long-standing anti-Black structural oppression in the United States, social capital may be associated with health differently for Black people than for other racial/ethnic groups. Our aim was to examine the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there is differential item functioning (DIF) in social capital according to race. DIF examines how items are related to a latent construct and whether this relationship differs across groups such as different racial groups. We used data from respondents to the Southeastern Pennsylvania Household Health Survey in 2004, who lived in Philadelphia (n = 2,048), a city with a large Black population. We used item response theory analysis to test for racial DIF. We found DIF across the items, indicating measurement error, which could be related to the way these items were developed (i.e., based on cultural assumptions tested in mainstream White America). Hence, our findings underscore the need to interrogate the assumptions that underly existing social capital items through an equity-based lens, and to take corrective action when developing new items to ensure that they are racially and culturally congruent.

Social capital and cost-related medication nonadherence (CRN): A retrospective longitudinal cohort study using the Health and Retirement Study data, 2006-2016.

Prescription drug spending and other financial factors (e.g., out-of-pocket costs) partially explain variation in cost-related medication nonadherence (CRN). Indicators of social capital such as neighborhood factors and social support may influence the health and well-being of older adults as they may rely on community resources and support from family and peers to manage conditions. Previous research on the relationship of social capital and CRN has limited evidence and contradictory findings. Hence, our objective is to assess the relationship of social capital indicators (neighborhood social cohesion, neighborhood physical disorder, positive social support, and negative social support) and CRN using a longitudinal design, 2006 to 2016, in a nationally representative sample of older adults in the United States (US). The Health and Retirement Study is a prospective panel study of US adults aged ≥ 50 years evaluated every two years. Data was pooled to create three waves and fitted using Generalized Estimating Equation modelling adjusting for both baseline and timevarying covariates (age, sex, education, race, total household income, and perceived health status). The three waves consisted of 11,791, 12,336, and 9,491 participants. Higher levels of neighborhood social cohesion and positive social support were related with lower CRN (OR 0.92, 95% CI 0.88-0.95 and OR 0.77, 95% CI 0.70-0.84, p<0.01). In contrast, higher levels of neighborhood physical disorder and negative social support were related to higher CRN (OR 1.07, 95% CI 1.03-1.11 and OR 1.46, 95% CI 1.32-1.62, p<0.01). Interventions targeting social capital are needed, reinforcing positive social support and neighborhood social cohesion and diminishing neighborhood physical disorder and negative social support for older adults.

Advancing pharmacist prescribing privileges: Is it time?

OBJECTIVES: The rising cost of health care, impact of the aging population, physician shortages, and access to care issues have stressed the U.S. health care system. There is no single solution to combat the complexity of issues concerning the health care system; however, there are potential solutions, such as expanding the role of pharmacists, in efforts to alleviate some stress. Advancing the scope of pharmacy practice with the inclusion of autonomous prescribing authority may enhance access to health care if barriers to pharmacist-provided patient care are removed. Understanding the perceptions of pharmacists, providers, and patients regarding the expansion of prescribing privileges may assist in this effort. SUMMARY: Collaborative practice agreements between physicians and pharmacists have fostered the expansion of the role of pharmacists; however, autonomous prescriptive authority for pharmacists would promote access to vaccines, naloxone for opioids, hormonal contraceptives, travel medications, tobacco cessation medications, and more. Before experiencing the integration of a pharmacist into their practice, an initial concern of physicians consisted of not fully understanding the role of pharmacists. Additional concerns in advancing the pharmacy profession include liability, provider-provider communication, payment for services, as well as training and inadequate infrastructure. CONCLUSION: Among the states that have expanded prescriptive authority for pharmacists, experiences among stakeholders have been positive. As with any major change, it will take time to implement proper structures and processes, with continuous revisions to address barriers and challenges that may arise. There will be a need for training as well as educating various stakeholders about the changes in the scope of pharmacy practice. Leveraging the experience of states that already have prescriptive authority protocols in place can aid in this endeavor. Limiting pharmacists by not providing prescriptive authority would not be a good alternative-tapping into an underused resource is better than reinventing the wheel.