Christina A. Spivey

Resilience in undergraduate social work students: Social support and adjustment to academic stress

The purpose of this exploratory study was to analyze the relationship between academic stress and resilience in American, undergraduate social work students (N = 145), and to identify whether social support functioned as a protective factor amid this relationship. Testing social support within models of mediation and moderation served this purpose. Surveys were submitted to three social work programs and solicited empirical data on academic stress; social support and two subsystems, family and friend support; and perceived resilience. The sample reported moderate levels of academic stress, social support, and resilience. Academic stress significantly (p < 0.05), negatively influenced social support and resilience. Social support systems exerted significant, positive influence with each other and with resilience. No social supports mediated the negative stress effect on resilience. Friend support moderated the academic stress–resilience relationship. Implications for social work educators and field agency practitioners regarding enhancement of supportive peer relationships among undergraduate students are discussed.

Immunosuppressant therapy adherence and graft failure among pediatric renal transplant recipients

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 (≤18 years) who received their only transplant during 1995–2000, experienced graft survival more than 6 months posttransplant, had 36 months of USRDS data (or had data until graft failure or death), utilized Medicare IST coverage, and were prescribed cyclosporine/tacrolimus were included. IST adherence was measured by medication possession ratio (MPR). Cox proportional hazards analysis was used to assess the relationship between time to graft failure and continuous MPR. MPR quartiles were used to examine MPR as a categorical variable (Quartile 4 = adherent group, Quartiles 1–3 = nonadherent group). Kaplan–Meier estimates of time to graft failure were compared between adherent and nonadherent groups. 877 RTRs met inclusion criteria. Cox proportional hazards modeling suggested that greater adherence was significantly associated with longer time to graft failure (p = 0.009), after adjusting for relevant clinical factors. Kaplan–Meier analysis found a difference between adherent and nonadherent groups in graft survival by time (χ2= 5.68, p = 0.017). Interventions promoting adherence should be implemented among pediatric RTRs and parents/guardians to optimize graft survival.

Improving outcomes of renal transplant recipients with behavioral adherence contracts: a randomized controlled trial.

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.

The 'cost' of medication nonadherence: Consequences we cannot afford to accept

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.

Associations of characteristics of renal transplant recipients with clinicians' perceptions of adherence to immunosuppressant therapy.

Background. The objective of the study was to determine surveillance criteria for renal transplant recipients (RTRs) at highest risk for immunosuppressant therapy nonadherence. Methods. Retrospective analyses were performed on follow-up data in the United States Renal Data System. Those who received transplants between January 1, 1995 and December 31, 2002, had at least 36 months of follow-up data, and did not receive a second renal transplant were included in the analyses. The risk of nonadherence was estimated by random effects logistic regression while controlling for age, gender, race, education, donor type, primary insurance, time since transplant, and immunosuppressant medications using the STATA software (College Station, TX). Association between nonadherence and graft failure was also examined. Results. A total of 53,997 individuals met the inclusion criteria. About 6% of RTRs were reported nonadherent. Nonadherence risk increased with time posttransplant and decreased with age (P<0.001). RTRs who were male, nonwhite, or used mycophenolate mofetil or tacrolimus were more likely to be nonadherent with odds ratios (OR) of 1.36, 1.99, 1.13, and 1.31, respectively (P<0.05) than RTRs who used cyclosporine, steroids, azathioprine, or had Medicare (P<0.05). Nonadherent RTRs were more likely to experienced graft failure (P<0.001). Conclusions. Interventions to improve adherence should target younger RTRs, male RTRs, nonwhite RTRs, and those not on Medicare to reduce risk of graft failure.

Social support and immunosuppressant therapy adherence among adult renal transplant recipients.

Chisholm‐Burns MA, Spivey CA, Wilks SE. Social support and immunosuppressant therapy adherence among adult renal transplant recipients.
Clin Transplant 2010: 24: 312–320.

Reference List Accuracy in Social Work Journals

This exploratory study investigated the rate of citation errors in the reference lists of five social work journals. High error rates have been found in journals in fields such as medicine and psychology but have not yet been investigated in social work journals. A stratified, computer-generated random sample was selected (N = 500, 100 per journal), and each reference was verified against the original work for accuracy in six fields: article title, author name(s), journal title, pagination, volume, and year. In examining the total sample of 500 references across the five journals, 206 references (41.2%) contained at least one error. Suggestions for reduction of error rates are discussed, as are suggestions for future study in this area.

Pharmacoadherence: A new term for a significant problem

In 2003, the World Health Organization declared nonadherence to medical treatment a major public health concern, particularly among patients with chronic conditions.[1][1] Research has found that adherence to long-term treatment regimens associated with chronic conditions is problematic,[2][2]–[6

Impact of clinical pharmacy services on renal transplant recipients’ adherence and outcomes

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.

Assessment of and recommendations to improve pharmacy faculty satisfaction and retention

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 Pearsons 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.