Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation.

This study was conducted to identify processes of coping with COVID-19 and determine their impact on emotional well-being for women of color in the United States. Data were collected from 368 women between May and July 2020 using an online survey guided by the Transactional Model of Stress and Coping, which included an assessment of COVID-19 stressors, Brief Encounter Psychosocial Instrument (BEPSI), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), Ways of Coping Questionnaire (WCQ), and Center for Epidemiologic Studies Depression Scale (CES-D). Over half of the women were depressed (59.0%) and felt ill (69.3%) from the stress of COVID-19. Planful problem solving (M = 4.58, SD = 2.70) was the primary way to cope with COVID-19. A small, positive correlation existed between COVID-19 stressors and depressive symptoms (r = 0.27, p < .001). COVID-19 had a significant impact on the increase of stress (MI = 0.53, p < .001) and depressive symptoms (MI = 5.90, p < .001) as well as the decrease of resilience (MD = 2.17, p < .001) for women of color in the United States. These results can be translated into actionable care plans for clinicians and public health professionals that inform the development of tailored, culturally appropriate, equitable, and gender-specific mental health care for women of color in the age of COVID-19.

The COVID pandemic cast a harsh light on the structural and systemic health inequalities that exist in American society and in U.S. medical education. Black and Brown communities were disproportionately affected, and the pandemic highlighted the need for a diverse physician and healthcare workforce. Both the lack of equitable, high-quality healthcare in underrepresented communities and the obstacles that students who are underrepresented in medicine (URiM) experience in medical school are direct consequences of the structural racism that flourishes in U.S. medical schools and healthcare institutions. In this article, we explain structural racism and how it has manifested itself in medical education, including the lack of diversity among faculty and leadership, implicit biases and stereotypes about people of color, and discriminatory language used in evaluations of URiM students. We conclude with potential solutions for addressing structural racism in medical education. These include increasing diversity among faculty and leadership, implementing antiracist curricula, and providing mentorship and support for URiM students. Ultimately, we aim to promote discussion and action to eliminate structural racism in medical education in America.