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Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.

Objective. To project the net cumulative income break-even point between practicing pharmacists and those who enter the workforce directly after high school graduation or after obtaining a bachelor's degree. Methods. Markov modeling and break-even analysis were conducted. Estimated costs of education were used in calculating net early career earnings of high school graduates, bachelor's degree holders, pharmacists without residency training, and pharmacists with residency training. Results. Models indicate that over the first 10 years of a pharmacist's career, they accumulate net earnings of $716 345 to $1 064 840, depending on cost of obtaining the PharmD degree and career path followed. In the break-even analysis, all pharmacy career tracks surpassed net cumulative earnings of high school graduates by age 33 and bachelor's degree holders by age 34. Conclusion. Regardless of the chosen pharmacy career track and the typical cost of obtaining a PharmD degree, the model under study assumptions demonstrates that pharmacy education has a positive financial return on investment, with a projected break-even point of less than 10 years upon career entry.

Objective: To assess first-year (P1) pharmacy students' studying behaviors and perceptions after implementation of a new computerized "composite examination" (CE) testing procedure., Methods: Student surveys were conducted to assess studying behavior and perceptions about the CE before and after its implementation., Results: Surveys were completed by 149 P1 students (92% response rate). Significant changes between survey results before and after the CE included an increase in students' concerns about the limited number of questions per course on each examination and decreased concerns about the time allotted and the inability to write on the CEs. Significant changes in study habits included a decrease in cramming (studying shortly before the test) and an increase in priority studying (spending more time on one course than another)., Conclusion: The CE positively changed assessment practice at the college. It helped overcome logistic challenges in computerized testing and drove positive changes in study habits.

Objective. To evaluate the economic value of pharmacy education/career and the effects of the cost of private or public pharmacy school, the length of degree program, residency training, and pharmacy career path on net career earnings. Methods. This study involved an economic analysis using Markov modeling. Estimated costs of education including student loans were considered in calculating net career earnings of 4 career paths following high school graduation: (1) immediate employment; (2) employment with bachelor's degree in chemistry or biology; (3) employment as a pharmacist with no residency training; and (4) employment as a pharmacist after completing one or two years of residency training. Results. Models indicated that throughout their careers (up to age 67), PharmD graduates may accumulate net career earnings of $5.66 million to $6.29 million, roughly 3.15 times more than high school graduates and 1.57 to 1.73 times more than those with bachelor's degrees in biology or chemistry. Attending a public pharmacy school after completing 3 years of prepharmacy education generally leads to higher net career earnings. Community pharmacists have the highest net career earnings, and PGY-1 residency-trained hospital pharmacists have greater net career earnings than those who immediately started their careers in a hospital setting. Conclusion. The economic models presented are based on assumptions described herein; as conditions are subject to variability, these models should not be used to predict future earnings. Nevertheless, the findings demonstrate investment in a pharmacy education yields favorable financial return. Application of results to schools of pharmacy, students, and graduates is discussed.

Objective. To examine the early stages of a student giving program, to evaluate the program's influence on college donations, and to evaluate other factors that may affect student and year-one postgraduation giving at a college or school of pharmacy. Methods. A review of student records for graduates of 2013 and 2014 was conducted. Data included student characteristics, scholarship support, international program participation, senior class gift participation, and postgraduation giving. Mann-Whitney U, Kruskal-Wallis, Wilcoxon signed-rank, and Chi-square analyses were performed. Results. Of 273 graduates, the majority were female (57.1%) and white (74%). Class of 2014 contributed a higher amount to the class gift than the prior class. In 2014, those who received scholarships gave higher amounts to the class gift. For the combined classes, there was an association between the number of students who gave pregraduation and the number who gave postgraduation. In the 2013 class, individuals gave greater amounts postgraduation compared to pregraduation, and a higher percentage of alumni (8%) gave postgraduation compared to alumni from the previous class (<1%). Conclusion. Participation in year-one postgraduation giving increased after implementation of the senior class gift program. Receiving scholarships influenced giving to the class gift but was not associated with postgraduation giving. Future studies are needed to develop a more comprehensive understanding of student and alumni philanthropy.

Objective: To examine relationships among students' Pre-NAPLEX scores and prepharmacy, pharmacy school, and demographic variables to better understand factors that may contribute to Pre-NAPLEX performance., Methods: A retrospective review of pharmacy students' Pre-NAPLEX scores, demographics, prepharmacy factors, and pharmacy school factors was performed. Bivariate (eg, ANOVA) and correlational analyses and stepwise linear regression were conducted to examine the significance of various factors and their relationship to Pre-NAPLEX score., Results: 168 students were included, with the majority being female (60.7%) and White (72%). Mean Pre-NAPLEX score was 68.95 ± 14.5. Non-Hispanic White students had significantly higher Pre-NAPLEX scores compared to minority students (p<0.001). Pre-NAPLEX score was correlated (p<0.001) to race/ethnicity (r=-0.341), PCAT score (r=0.272), and pharmacy school GPA (r=0.346). The regression model (adjusted R(2)=0.216; p<0.001) included pharmacy school GPA, academic probation, academic remediation, and PCAT composite., Conclusion: This study highlighted that select demographic, prepharmacy, and pharmacy school factors were associated with Pre-NAPLEX outcomes. Such factors may assist colleges/schools of pharmacy in identifying students who may be at risk for poorer NAPLEX performance and may need greater preparation.

Objective: Medication therapy management (MTM) has the potential to play an instrumental role in reducing racial and ethnic disparities in health care. However, previous research has found that Blacks and Hispanics are less likely to be eligible for MTM. The purpose of the current study was to examine the potential effects of MTM eligibility criteria on racial and ethnic disparities in health outcomes., Methods: The current study is a retrospective cross-sectional analysis of the Medicare Current Beneficiary Survey Cost and Use files for the years 2007 and 2008. A difference-in-differences model was used to compare disparities in outcomes between ineligible and eligible beneficiaries according to MTM eligibility criteria in 2010. This was achieved by including in regression models interaction terms between dummy variables for Blacks/Hispanics and MTM eligibility criteria. Interaction terms were interpreted on both multiplicative and additive terms. Various regression models were used depending on the types of variables., Key Findings: Whites were more likely to report self-perceived good health status than Blacks and Hispanics among both MTM-eligible and MTM-ineligible populations. Disparities were greater among MTM-ineligible than MTM-eligible populations (e.g., on additive term, difference in odds=1.94 and P<0.01 for Whites and Blacks; difference in odds=2.86 and P<0.01 for Whites and Hispanics). A few other measures also exhibited significant patterns., Conclusions: MTM eligibility criteria may exacerbate racial and ethnic disparities in health status and some measures of health services utilizations and costs and medication utilization. Future research should examine strategies to remediate the effects of MTM eligibility criteria on disparities.

The objective was to use the United States Renal Data System (USRDS) to quantify the relationship between immunosuppressant therapy (IST) adherence and risk of graft failure among adult renal transplant recipients (RTRs). A secondary objective was to examine the relationship among select patient characteristics and IST adherence. The study sample included adult RTRs who: received primary transplant between January 1, 1999 and December 31, 2005; experienced graft survival for at least 12 months post-transplant and had at least 12 months of data in the USRDS; utilized Medicare coverage for IST; and were prescribed cyclosporine or tacrolimus. IST adherence was measured by medication possession ratio (MPR). Pearson chi-square tests were used to examine associations between patient characteristics and MPR quartiles. Cox proportional hazards regression was used to assess relationships among time to graft failure, MPR, and patient characteristics. Thirty-one thousand nine hundred and thirteen RTRs met inclusion criteria. Older age, female gender, white race, deceased donors, and tacrolimus were associated with greater adherence (p < 0.001). Cox proportional hazard modeling indicated greater adherence, white race, and having a living donor were significantly associated with longer graft survival (p < 0.05). Future prospective studies should further examine the clinical significance of IST nonadherence as it relates to graft failure., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Among kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients., Methods: We performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support., Results: The 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10-11, and 14.3% scored 0-9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P < 0.001). Several individual barriers were associated with non-adherence., Conclusions: Among prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions.

The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n = 76) had higher adherence than control group RTRs (n = 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR = 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs., (© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.)

This report describes the experiences of the University of Tennessee College of Pharmacy over 20 years with an international capstone educational experience for students. Although the university provides reciprocal opportunities to international students, this report focuses on the experiences of the college's pharmacy students who have participated in the program. This capstone course is offered as an elective course in the advanced pharmacy practice experience (APPE) component of the college's experiential program. Goals of the program and a brief description of its organizational structure are provided. Results of a structured student satisfaction survey and a survey covering the most recent 3 years of the program are presented. This program has greatly broadened participants' cultural horizons and expanded their global view and understanding of the contributions of pharmacy to health care.

Objectives: To evaluate scholarship, as represented by peer-reviewed journal articles, among US pharmacy practice faculty members; contribute evidence that may better inform benchmarking by academic pharmacy practice departments; and examine factors that may be related to publication rates., Methods: Journal articles published by all pharmacy practice faculty members between January 1, 2006, and December 31, 2010, were identified. College and school publication rates were compared based on public vs. private status, being part of a health science campus, having a graduate program, and having doctor of pharmacy (PharmD) faculty members funded by the National Institutes of Health (NIH)., Results: Pharmacy practice faculty members published 6,101 articles during the 5-year study period, and a pharmacy practice faculty member was the primary author on 2,698 of the articles. Pharmacy practice faculty members published an average of 0.51 articles per year. Pharmacy colleges and schools affiliated with health science campuses, at public institutions, with NIH-funded PharmD faculty members, and with graduate programs had significantly higher total publication rates compared with those that did not have these characteristics (p<0.006)., Conclusion: Pharmacy practice faculty members contributed nearly 6,000 unique publications over the 5-year period studied. However, this reflects a rate of less than 1 publication per faculty member per year, suggesting that a limited number of faculty members produced the majority of publications.

Objective: To examine the relationship between health-related quality of life (HQoL) and employment status in renal transplant recipients (RTRs)., Methods: Eighty-two RTRs met inclusion criteria: 21-65 yr of age; greater than one yr post-transplant; and received calcineurin inhibitors. A cross-sectional survey was conducted using a demographics questionnaire and the following HQoL instruments: SF-12 Health Survey version 2 (Physical Component Summary [PCS-12] and Mental Component Summary [MCS-12]) and Kidney Transplant Questionnaire (KTQ). Two multivariate logistic regression analyses (SF-12 model and KTQ model) were conducted to determine whether HQoL and demographic variables were independently associated with employment status., Results: Seventy-five RTRs were included in the analysis. Compared with employed RTRs, a greater number of unemployed RTRs were non-white, had lower education levels, and had deceased donor transplants (p < 0.05). Employed RTRs had significantly higher SF-12 scores (p < 0.05). In the SF-12 logistic regression model, PCS-12 and education level were significant predictors of employment status (p < 0.05). In the KTQ model, the Fatigue subscale and education level were significant predictors of employment status (p < 0.05)., Conclusions: Findings suggest higher PCS-12, higher KTQ-Fatigue, and education level are independently associated with employment status. Interventions targeted to improve HQoL, decrease fatigue, and increase education level are discussed., (© 2011 John Wiley & Sons A/S.)

Objectives: To examine trends in the numbers of women and underrepresented minority (URM) pharmacy faculty members over the last 20 years, and determine factors influencing women faculty members' pursuit and retention of an academic pharmacy career., Methods: Twenty-year trends in women and URM pharmacy faculty representation were examined. Women faculty members from 9 public colleges and schools of pharmacy were surveyed regarding demographics, job satisfaction, and their academic pharmacy career, and relationships between demographics and satisfaction were analyzed., Results: The number of women faculty members more than doubled between 1989 and 2009 (from 20.7% to 45.5%), while the number of URM pharmacy faculty members increased only slightly over the same time period. One hundred fifteen women faculty members completed the survey instrument and indicated they were generally satisfied with their jobs. The academic rank of professor, being a nonpharmacy practice faculty member, being tenured/tenure track, and having children were associated with significantly lower satisfaction with fringe benefits. Women faculty members who were tempted to leave academia for other pharmacy sectors had significantly lower salary satisfaction and overall job satisfaction, and were more likely to indicate their expectations of academia did not match their experiences (p<0.05)., Conclusions: The significant increase in the number of women pharmacy faculty members over the last 20 years may be due to the increased number of female pharmacy graduates and to women faculty members' satisfaction with their careers. Lessons learned through this multi-institutional study and review may be applicable to initiatives to improve recruitment and retention of URM pharmacy faculty members.

Objectives: To provide a brief overview of published immunosuppressant therapy (IST) adherence interventions in adult renal transplant recipients (RTRs) and to describe the utility and aspects of an adherence toolbox for adult RTRs., Setting: National independent specialty pharmacy., Practice Description: IST adherence is critical to graft survival after a renal transplant. However, IST nonadherence occurs in a large proportion of adult RTRs. Although effective intervention strategies are needed to improve IST adherence, few intervention studies have been conducted in the adult RTR population. To address this gap in the literature, a randomized controlled trial of a patient-specific behavioral contracts intervention to improve IST adherence among adult RTRs has been implemented., Practice Innovation: During the behavioral contracts intervention, researchers have developed a toolbox of practical and replicable items and strategies to address forgetfulness and confusion as barriers to IST adherence., Conclusion: An adherence toolbox that includes simple, practical, accessible mechanisms and strategies to improve IST adherence may benefit adult RTRs.

Objective: To provide a brief overview of the extent of medication nonadherence in the United States, its impact on patient health and health care costs, its causes, and possible strategies that health care practitioners can use to improve medication adherence., Summary: Medication use and health care costs have increased dramatically during the previous decade in the United States. Adherence to medication therapy often is a critical aspect of medical treatment, particularly the treatment of chronic conditions such as diabetes and hypertension. Despite the importance of adherence, medication nonadherence is a serious problem, with the World Health Organization noting that the average nonadherence rate is 50% among those with chronic illnesses. Consequences of nonadherence include worsening condition, increased comorbid diseases, increased health care costs, and death. Nonadherence results from many causes; therefore, no easy solutions exist. The first step to addressing nonadherence is to recognize that collaboration must occur between health care practitioners and patients to increase adherence, with the goal of achieving optimal health outcomes., Conclusion: The relationship between health care practitioners and patients and open, ongoing communication between the stakeholders are essential to combating medication nonadherence. Given their training and accessibility, pharmacists are well positioned to address nonadherence.

Purpose: A systematic review examining the economic effects of pharmacist-provided direct patient care on health outcomes in the United States was conducted., Methods: A comprehensive literature search was conducted using 13 academic and medical databases. Studies were included in the analysis if they described pharmacist-provided direct patient care, used comparison groups, evaluated economic outcomes, and were conducted in the United States. Outcome results were categorized as (1) favorable, indicating significant improvement as a result of pharmacists' interventions or services, (2) not favorable, indicating significant improvement as a result of nonpharmacist care, (3) mixed, having favorable results on one measure of a study variable but not favorable results or no effect on another, (4) having no effect, indicating no significant difference between pharmacists' interventions or services and the comparison, or (5) unclear, indicating the outcome could not be determined based on presented data., Results: Of the 56,573 citations considered, a total of 126 studies met the criteria for inclusion in this systematic review. Results favoring pharmacist-provided care were found in 20 studies (15.9%), mixed results were seen in 53 studies (42.1%), no effect was found in 6 studies (4.8%), and unclear results were found in 47 studies (37.3%)., Conclusion: A majority of studies examining the economic effects of pharmacist-provided direct patient care in the United States were limited by their partial cost analyses, study design, and other analysis considerations. A majority of the 20 studies that found positive economic benefits examined pharmacists' interventions involving technical methods or multimodal approaches.

Background: The purpose of the study was to assess the relationship between social support and immunosuppressant therapy adherence among adult renal transplant recipients., Methods: A cross-sectional, survey design was employed. Mailed questionnaires were used to collect data from 81 recipients, and included the Immunosuppressant Therapy Adherence Scale (ITAS and Modified Social Support Survey (MSSS-5). The correlation between ITAS and MSSS-5 summary scores was assessed using the correlation coefficient (r). Analyses of the following relationships were conducted using correlation coefficients: (i) ITAS summary score and individual items of the MSSS-5; and (ii) MSSS-5 summary score and individual items of the ITAS. A hierarchical regression was conducted., Results: The response rate was 74%. The relationship between social support and adherence was significant (r = 0.214, p < 0.05). Two MSSS-5 items (affectionate support and instrumental support pertaining to household functions) were related to ITAS summary score (p < 0.05), and one ITAS item (forgetfulness) was related to the MSSS-5 summary score (p < 0.05). The regression model (all MSSS-5 items) accounted for 24% of the variation in ITAS summary scores., Conclusions: The findings suggest that strategies utilizing social support to address forgetfulness as well as strategies to improve affectionate support and instrumental support related to daily household functions may be useful adherence intervention tools.

Purpose: Variations in the medication treatment received by racial and ethnic minorities and women and the negative health outcomes associated with these differences were examined., Methods: Studies published between January 1990 and June 2008 were identified via electronic searches of MEDLINE, PsychINFO, International Pharmaceutical Abstracts, PubMed, and CINAHL using search terms related to race, ethnicity, sex, drug treatment, and disparity or variation. Articles were excluded if they addressed only medical or surgical care or did not include a statistical analysis of differences in drug treatment based on race, ethnicity, or sex. Data regarding the frequency of reported race, ethnic, and sex differences in medication treatment, the types of treatment differences observed, and associated health outcomes were extracted., Results: A total of 311 research articles were identified that investigated whether race, ethnicity, or sex was associated with disparities in medication treatment. Seventy- seven percent (n = 240) of included articles revealed significant disparities in drug treatment across race, ethnicity, and sex (p < 0.05). The most frequent disparity, found in 73% of the articles studied, was differences in the receipt of prescription drugs; however, documented disparities occurred related to differences in the drugs prescribed, drug dosing or administration, and wait time to receipt of a drug. Documented outcomes associated with pharmacotherapeutic disparities included increased rates of hospitalization, decreased rates of therapeutic goal attainment (e.g., low- density-lipoprotein cholesterol, blood pressure goals), and decreased rates of survival., Conclusion: A literature review revealed significant disparities in the medication treatment received by racial and ethnic minorities and women.

Rationale: The objective of this study was to conduct a psychometric re-evaluation of the immunosuppressant therapy adherence scale (ITAS), a self-report measure of immunosuppressant therapy (IST) adherence targeted to solid-organ transplant recipients., Methods: Mailed questionnaires were used to collect data from 141 transplant recipients. A factor analysis of the ITAS was conducted. Validity was examined via Pearson's product-moment correlations (r) to theoretically tied measures of social support and resilience. Cronbach's and split-half alpha coefficients determined internal consistency., Results: The response rate was 72.3%. The aggregate mean on ITAS' summed scores was 11.0 (standard deviation = 1.7). The single IST adherence factor had an eigenvalue of 2.92 and accounted for 73% of the scale items' variance. Component loadings for ITAS items were high (> or = 0.80). Zero-order correlations among scale items were moderately strong (> or = 0.57) and significant (P < 0.01). ITAS summed scores were significantly associated with measures of social support and resilience (r > or = 0.20, P < 0.05). Cronbach's alpha was 0.87. The Guttman split-half coefficient was 0.90., Conclusions: This re-evaluation provides needed confirmation that the ITAS is a valid and reliable measure of IST adherence. The ITAS may be useful as an IST adherence measure in the outpatient transplant clinic setting as it is easy to administer, brief and less expensive than many other adherence measures.

The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (

Purpose: The level of job satisfaction and items associated with job satisfaction are examined among pharmacy faculty in the United States., Methods: An Internet-based survey was developed and distributed via e-mail to randomly selected faculty. The survey questionnaire was developed based on items used in previous surveys related to faculty job satisfaction and included a seven-item job satisfaction measure, satisfaction with work- and career-related items, items regarding the work environment, and demographic information. Analysis of variance and Pearson's correlation coefficient were used to analyze the relationship among variables., Results: Out of 1000 faculty members who received the survey, 266 responded. The mean +/- S.D. level of global job satisfaction for faculty was 3.82 +/- 0.77. Global satisfaction and salary satisfaction were associated with higher salary level (p < 0.001). Low-to-moderate levels of satisfaction were found for several work and career items. Female faculty members were less satisfied with time for family and personal needs compared with male faculty (p < 0.001). Pharmacy practice faculty members were significantly more satisfied with working in an intellectually challenging environment compared with nonpharmacy practice faculty (p < 0.001)., Conclusion: Although pharmacy faculty members experience moderate levels of job satisfaction, there are several work and career and work environment areas in which improvement in satisfaction is needed. Provision of competitive salaries and development of a stimulating, supportive institutional culture may increase job satisfaction and facilitate improved faculty retention.

Purpose: Relationships between adherence to immunosuppressant therapy and adult renal transplant recipients' age, time posttransplant, race, and sex were evaluated to identify factors that predict nonadherence., Methods: Pharmacy refill data were used to measure adherence. In a primary analysis, stepwise regression was used to assess the relationship between independent variables (age, sex, time posttransplant, and race) and adherence. In a secondary analysis to provide categorical summaries, stepwise regression was used to assess the relationship between independent variables (age quartiles, sex, time posttransplant quartiles, and race) and adherence., Results: In the primary analysis, age and time posttransplant were significant predictors of adherence rate (p < 0.05), with adherence rate decreasing as age and time posttransplant increased. In the secondary analysis, age quartile 4 (>or=60 years) and time posttransplant quartile 1 (

The purpose of this article is to provide a description of a clinical pharmacy services program implemented in a renal transplant clinic to improve medication access and adherence as well as health and economic outcomes among renal transplant recipients (RTRs). Following a team-based planning process and an informal survey of RTRs, a clinical pharmacy service intervention was implemented in the Medical College of Georgia renal transplant clinic. As part of the intervention, a clinical pharmacist reviewed and optimized medication therapy, provided instructions on how to take medication, and assisted with enrollment into medication assistance programs. Significant differences were found between RTRs who did and did not receive clinical pharmacy services on measures of adherence, health, economics, and quality of life. Clinical pharmacy services, as described in this article, have a positive impact on renal transplant recipients' medication adherence, health and economic outcomes, and health-related quality of life. The findings described here suggest that clinical pharmacy services are a viable and effective option for improving care for RTRs in an outpatient clinic setting.