The purpose of this study was to investigate the impact of Medicare Part D on prescription utilization, health services utilization, and health care expenditures in the general Medicare population – as well as Medicare sub-populations, including non-Hispanic blacks (NHBs), Hispanics, near poor individuals, and persons with higher disease burden. A retrospective analysis of Medicare beneficiaries (N=32,228) was conducted using the Medical Expenditure Panel Survey 2002 to 2009 data. Multivariable quantile regression was used to estimate the following outcomes, adjusting for socio-demographic characteristics: 1) number of prescription fills; 2) out-of-pocket (OOP) drug expenditures; 3) total drug expenditures; 4) OOP health care expenditures; 5) total health care expenditures; 6) number of hospitalizations; and 7) number of emergency department (ED) visits between the pre-Part D (2002-2005) and post-Part D (2006-2009) periods. All expenditures were inflation-adjusted to 2009 dollars. The average age of the study sample was 71.0 (SD=14.5). In the general Medicare population, Part D was associated with decreases in OOP drug expenditures (-25.7% to -33.6%; p<0.0001) and OOP health care expenditures (-22.1% to -24.3%; p<0.0001) as well as increases in the number of prescription fills (5.8% to 8.4%; p<0.0001) and total drug expenditures (75th percentile: 5.5%; 90th percentile: 10.2%; p<0.0001). Part D was not associated with changes in total health care expenditures in the general Medicare population. Changes in hospitalizations and ED visits were tested at the 90th percentile, and the results were not statistically significant. In sub-group analyses based on race/ethnicity, non-Hispanic whites (NHWs) experienced more significant reductions in OOP drug and/or health care expenditures when compared with NHBs and Hispanics. Near poor beneficiaries experienced larger reductions in OOP drug expenditures than beneficiaries with middle- to high-income, while Medicare beneficiaries with three or more conditions experienced more substantial reductions in OOP drug and OOP health expenditures after Part D was introduced, compared with those with fewer than three conditions. Part D resulted in increases in medication utilization and reductions in OOP drug and OOP health care expenditures among Medicare beneficiaries. Part D was not associated with differences in total health care spending. The effects of Part D were more pronounced in Medicare subgroups, including NHWs, near poor individuals, and patients with higher chronic disease burden. / text

This study examined the relationships between cultural characteristics, communication variables, and medical outcomes in HIV-positive racial/ethnic minority patients. Participants included 33 patients and 5 providers across two urban, community medical clinics. The patient sample was 61% African American, 24% Latino, and 15% Other/Mixed. The majority (73%) were male. Providers included one White female physician, one White male nurse practitioner, two White female nurse practitioners, and one White male physician assistant. In this descriptive study, patients completed self-report ratings of their desire for engagement in decision-making prior to their scheduled medical consultation. After their consultations, patients rated their provider regarding engagement in decision-making, interpersonal communication, and working alliance. Patients also completed measures of acculturation, fatalism, familism, and mistrust. Providers rated their engagement of patients in decision-making, the patients’ interpersonal style, and working alliance immediately after the consultation. Measures of CD4 count and viral load were obtained from patients’ medical records. Cultural characteristics were not related to patient desire for engagement in decision-making. Patient perceptions of being highly informed and involved in decision-making were not related to satisfaction or immune functioning. Patient perceptions of provider affiliation and control, and the complementarity between these two, were also not found to have any significant relation to satisfaction or immune functioning. Though working alliance was not found to have a significant relation to any outcome, the relation between patient perception of a stronger working alliance and higher satisfaction was marginally significant. A match between patient and provider on the bond subscale of working alliance was found to correspond to IMI affiliation complementarity. Though the hypotheses were not supported, certain demographic variables were significantly associated with outcomes. For example, use of antiretroviral medications was associated with lower viral load and gender (i.e., being male) was related to lower CD4. The limitations of this study and directions for future research are discussed.

Extensive research has documented the experiences and outcomes of women and certain underrepresented racial/ethnic minority groups in STEM educational programs. This paper contributes to current conversations by focusing on the experiences of individuals that identify as both a racial/ethnic and sexual/gender minority (SGM). This paper has two major objectives in mind: (1) provide one of the first empirical studies examining the experiences of SGM students in STEM and (2) interrogate the intersection of racial/ethnic identity and sexual/gender identity within the context of these programs. In order to provide a more robust understanding in these areas, this paper is guided by the following research questions: (1) What are the experiences of students who identify as both a racial/ethnic and sexual/gender minority in STEM educational programs, (2) in what ways do these students' sexual/gender and racial/ethnic identity influence these experiences, (3) do racial/ethnic and sexual/gender minorities feel a sense of belonging within their respective programs and why, and (4) how do racial/ethnic and sexual/gender minorities perceive they are treated by peers, faculty, and staff within these programs. This paper takes a mixed-method approach, incorporating both interviews and quantitative survey data to gain insights into these questions. Upon analysis, major findings demonstrated that students experiences an erasure of student diversity in the classroom, while also experiencing higher salience with their sexual/gender identity when compared to their racial/ethnic identity.

<div> <p>In the last several years, it has become apparent that racial/ethnic minority graduate students face an increased risk for mental health issues (Clark, Mercer, Zeigler-Hill, & Dufrene, 2012; Paradies et al., 2015). Contextualizing their experiences and determining what factors play a role in increasing this risk specifically for racial/ethnic minority graduate students could help provide information about areas for intervention. However, there is a lack of literature on the experiences of racial/ethnic minorities in graduate school and the implications of those experiences for their mental health. It is important to understand their experience in the context of minority status stress through the use of Stress Process Theory (Pearlin, Menaghen, Lieberman, & Mullan, 1981). As such I hypothesized several positive and unique contributions to depressive symptoms by career and education barriers and minority status stress. Additionally, I hypothesized that minority status stress would mediate the relationship between career and education barriers and depressive symptoms, and that perceived family social support would moderate the relationships between career and education barriers, minority status stress, and depressive symptoms. To this end I used this regression-based, quantitative study to examine the associations between the perception of career and education barriers, minority status stress, perceived family social support, and depressive symptoms among a sample (<i>N</i> = 311) of domestic racial/ethnic minority graduate students currently enrolled in degree granting programs. The results revealed that the perception of career barriers uniquely contributed to depressive symptoms, although not in the hypothesized direction with career barriers being a negative predictor of depressive symptoms. Minority status stress uniquely contributed to depressive symptoms in the hypothesized directions and serves as a mediator between the perception of career barriers and depressive symptoms. The perception of education barriers did not uniquely contribute to depressive symptoms. Additionally, perceived family social support moderated only the relationship between the perception of career barriers and depressive symptoms; a moderator effect was not found in any other relationship. Implications for future research and practice, as well as the study’s limitations are discussed<b></b></p> </div> <b><br></b>