Gender equity perceptions among social and administrative science faculty: A qualitative evaluation.

BACKGROUND: Anecdotal evidence suggests that gender inequity persists in academic pharmacy. To date, there are limited published data about the perception of gender inequity in academic pharmacy. OBJECTIVE: The objective of this project was to determine themes associated with gender inequity perceptions in social and administrative science faculty from 2 national pharmacy organizations. METHODS: A gender equity task force comprising 13 members from Social and Administrative Sciences (SAS) sections of the American Pharmacists Association and the American Association of Colleges of Pharmacy was formed. The task force designed a semistructured interview guide comprising questions about demographics and core areas where inequities likely exist. When the survey invitation was sent to faculty members of the SAS sections via Qualtrics, faculty indicated whether they were willing to be interviewed. Interviews were conducted by 2 members of the task force via video conferencing application. The interviews were transcribed. Topic coding involving general categorization by theme followed by refinement to delineate subcategories was used. Coding was conducted independently by 3 coders followed by consensus when discrepancies were identified. RESULTS: A total of 21 faculty participated in the interviews. Respondents were primarily female (71%), were white (90%), had Doctor of Philosophy as their terminal degree (71%), and were in nontenure track positions (57%). Most respondents (90%) experienced gender inequity. A total of 52% reported experiencing gender inequity at all ranks from graduate student to full professor. Four major themes were identified: microaggression (57%), workload (86%), respect (76%), and opportunities (38%). Workload, respect, and opportunities included multiple subthemes. CONCLUSION: Faculty respondents perceive gender inequities in multiple areas of their work. Greater inequity perceptions were present in areas of workload and respect. The task force offers multiple recommendations to address these inequities.

Relationship between Health Literacy and Kidney Function.

AIM: Low health literacy (HL) may contribute to poor self-management of chronic kidney disease (CKD) and poor kidney function. This study aimed to assess the relationship between HL and estimated glomerular filtration rate (eGFR). METHODS: A cross-sectional observational study was conducted among consecutive eligible adult patients with CKD stages 1-4 attending an outpatient nephrology clinic. HL was assessed using Newest Vital Sign (NVS). eGFR was estimated using the Modification of Diet in Renal Disease equation. CKD self-management behaviour knowledge was assessed using a study instrument (CKD self-management knowledge (SMKT)). RESULTS: One hundred fifty patients participated in the study (83% participation rate). The prevalence of high likelihood of limited HL was 32.7%. Participants' eGFRs ranged from 17 to 152 mL/min / 1.73 m(2) , with over 80% of the eGFRs below 60 mL/min / 1.73 m(2) . HL was associated with eGFR after controlling for all demographics except age, race and gender (which are included in eGFR equation) (P = 0.05). Every unit increase in NVS score was associated with a 1.9% increase (95% confidence interval = 0 to 3.86%) in eGFR (model R square = 0.23, P = 0.002), which remained significant after controlling for CKD-SMKT (P = 0.05; model R square = 0.28, P < 0.001). The relationship was non-significant after controlling for age, although it remained significant after controlling for other demographics including gender and race. CONCLUSIONS: There is a small but significant association between HL and eGFR. Providers should use HL-tailored communication strategies in CKD patients. Larger multicentre studies are needed to substantiate this relationship.

Real-World Experiences of Parkinson's Disease OFF Time and Role of Demographics.

Purpose: OFF periods are episodes when Parkinson's disease (PD) medications work suboptimally, with symptoms returning and impacting quality of life. We aimed to characterize OFF periods using patient-reported frequency, severity, and duration, as well as determine these characteristics' associations with demographics. Methods: A retrospective cohort study using Fox Insight Data Exploration Network (Fox DEN) database was conducted. Eligible patients had PD and were >18 years. The experience of OFF periods was characterized by frequency (number of episodes/day), duration (duration/episode), and severity (impact on activities). Significance level was Bonferroni-corrected for multivariate analyses. Results: From a population of 6,757 persons with PD, 88% were non-Hispanic Whites (mean age: 66 ± 8.8 years); 52.7% were males versus 47.3% females; mean PD duration was 5.7 ± 5.2; and 51% experienced OFF periods. Subsequent analyses were limited to non-Hispanic Whites, as they constituted a large majority of the participants and were the subgroup that had the sample size to derive reliable inferences. The analyses showed that 67% experienced 1-2 episodes/day, 90% experienced >15-minute episodes, and 55% reported slight-mild severity/episode. Lower age was associated with a higher frequency (incidence rate ratio [IRR]: 0.992; P<0.001) and severity (odds ratio [OR]: 0.985; P=0.001) of OFF episodes. Income of <$35,000 was associated with 15.1% more episodes/day (IRR: 1.15, p<0.001) and 66.5% higher odds of a severe episode (OR: 1.66; P<0.001). Females experienced 7.5% more episodes compared to males (IRR: 1.075; P=0.003). Longer PD duration was associated with 1.3% more episodes/day (IRR: 1.013; P<0.001) and 10% higher odds of a severe episode (OR: 1.10; P<0.001). Conclusions: Lower age, income <$35,000, longer PD duration, female gender, and being unemployed are associated with a higher frequency and severity of OFF periods with no associations for duration/episode among non-Hispanic Whites with PD. In time-constrained clinic environments, clinicians should tailor OFF periods management counseling to vulnerable demographic groups to enhance care delivery.(J Patient Cent Res Rev. 2024;11:8-17.).

Seeking Gender Equity in Pharmacy Academia.

Gender inequity is a critical diversity, equity, and inclusion issue that has continued to lead to workplace disparities. While gender-based differences in pay are well documented, there are multiple other facets of academic worklife (eg, teaching, research, service, resources, etc) wherein gender inequities exist but have never been systematically identified or reported. The COVID-19 pandemic has further exacerbated these inequities. One reason for continued existence of gender disparities in the workplace is lack of focused attention and emphasis on this issue. A recently formed Gender Equity Task Force has taken the first steps to systematically explore gender inequity in all areas of academic pharmacy worklife. The purpose of this Commentary is to highlight the scope of the problem of gender inequity in pharmacy academia and offer solutions that the Academy can implement to mitigate the impact of gender inequity in the future.

Pharmacy Leaders' Reflections on Leadership and Legacy.

OBJECTIVE: To explore the experiences, contributions, and perceived legacy of individuals recognized as leaders in the pharmacy profession and compare these by gender and generational category. METHODS: A total of 54 leaders were interviewed about their journey to leadership and the legacy they leave to the profession. Interviews were transcribed, de-identified, and qualitatively analyzed using an inductive, modified constant comparison approach for open and axial coding. Qualitative responses were quantified to allow for the comparison of themes by gender and generational category. RESULTS: Common leadership themes included: humility, not expecting to be in a leadership role, taking initiative, being passionate about their work, having mentors to guide them, having a network of people around them, being a part of change, serving during a challenging time, seizing opportunities when they presented themselves, and being involved in professional organizations. The individual's clinical work (38.9%), helping to develop pharmacy as a clinical profession (33.3%), publications (29.6%), impact on students (29.6%), building programs (22.2%), involvement in organizations (20.4%), and impactful research (16.7%) were common themes noted in the legacy responses. CONCLUSION: Although there are many advancements still to be made, upcoming leaders would benefit from the journey and perceived legacy of these leaders as they carry the torch to advance the practice of pharmacy.

Pharmacy Leaders' Advice to Students Pursuing Leadership: A Qualitative Study.

INTRODUCTION: Leadership development is important both from a curricular standpoint and for continued advancement of the profession. Advice from current leaders in the profession may serve as a powerful motivator to students desiring to be leaders. The purpose of this qualitative study was to provide advice from experienced pharmacy leaders. METHODS: Fifty-four pharmacy leaders were identified based on pre-determined, specific criteria and by using a snowball sampling method. Interviews with leaders were conducted via Zoom to learn about their leadership journey, their legacy, and advice they would give students. The interviews were transcribed, de-identified and analyzed using the inductive, modified constant comparison approach for open and axial coding. Advice themes were compared by gender and generational category. RESULTS: The majority of the interviewees were male (69%), belonged to the Baby Boomer Generation (1946-1964, 59.3%), and held leadership positions in education (78%) and health systems (48%). Thirty-seven leadership advice themes were present. The topmost advice to students was to keep an open mind (35%) and to get involved in organizations (32%). Pieces of advice shared by both men and women leaders included: being open minded, getting involved in organizations, taking initiative, trying new or difficult things, and finding your passion. Keeping an open mind, and taking initiative were common across the three generations. CONCLUSION: Pharmacy leaders have insightful information for students aspiring to be future leaders. Leadership advice was similar by gender and generational category. Students would benefit in developing their leadership based on advice from the lived experience of pharmacy leaders. Future studies could examine students' perspectives on leadership advice.

Guidance for Qualitative Research Manuscripts in Pharmacy Education.

The goal of this Best Practice Review is to support researchers in successfully preparing and publishing qualitative research in pharmacy education. Standard practice from the literature and journals' guidance from related fields were reviewed, and recommendations and resources applicable to qualitative research in pharmacy education were compiled for researchers planning to conduct and publish qualitative research. This review provides recommendations, not requirements, for publication in the Journal and is intended to be a guide, especially for authors and reviewers relatively new to the field of qualitative research. Additionally, researchers planning to publish their qualitative research are advised to review available best practices and standards, such as the Consolidated Criteria for Reporting Qualitative Research checklist and the Standards for Reporting Qualitative Research. Given the diverse methodology of qualitative research, it is important for authors to provide sufficient details and justifications of selected methods for transparency and to report collected results in a manner that allows reviewers and readers to adequately assess the validity of their study and the applicability of the findings.

Reliability and Validity Evidence for an Academic Gender Equity Questionnaire.

Objective. The majority of practicing pharmacists and student pharmacists are women. However, instruments to assess perceptions of gender equity within pharmacy academia are not available. The objective of this research was to describe the psychometric analysis of a questionnaire developed to assess gender equity by a Gender Equity Task Force and to report reliability and validity evidence.Methods. A questionnaire with 21 items addressing the teaching, research, service, advancement, mentoring, recruitment, and gender of college leaders was created. The survey was distributed via email in December 2020 to all social and administrative science section members of two professional associations. Rasch analysis was performed to evaluate the reliability and validity evidence for the questionnaire.Results. After reverse coding, all items met parameters for unidimensionality necessary for Rasch analysis. Once adjacent categories were merged to create a 3-point scale, the scale and items met parameters for appropriate functionality. Items were ordered hierarchically in order of difficulty. The modified instrument and scale can be treated as interval level data for future use.Conclusion. This analysis provides reliability and validity evidence supporting use of the gender equity questionnaire in the social and administrative academic pharmacy population if recommended edits such as the 3-point scale are used. Future research on gender equity can benefit from use of a psychometrically sound questionnaire for data collection.

Knowledge of and barriers to health literacy in Illinois.

OBJECTIVE: To examine Illinois pharmacists' knowledge of and barriers to health literacy. DESIGN: Cross-sectional descriptive study. SETTING: Illinois, August to November 2009. PARTICIPANTS: 701 Illinois pharmacists. INTERVENTION: Mail survey. MAIN OUTCOME MEASURES: Pharmacists' knowledge (percent correct), mean barrier factors, and percent agreement of barrier items. RESULTS: Usable responses were obtained from 701 respondents out of 1,457 pharmacists receiving surveys (48.1%). Percent correct for knowledge items ranged from 31.5% to 95.4% with only 19% to 27% of respondents answering a majority of the items correctly. Pharmacists had poor knowledge (percent correct) about prevalence of low health literacy (31.5%), its relationship to years of schooling (46.9%) and its lack of relationship to reading comprehension (48.4%). Overall process and practice-related barrier domain items were the most important barriers. In particular, the most frequently cited barriers towards low health literacy interventions were lack of adequate time (90.4%), use of mail order (83.8%), and presence of convenient delivery mechanisms (82.8%), all process barriers. Majority of respondents (57.3%) agreed that lack of knowledge about health literacy and its consequences is a barrier. Significant differences existed for barrier factors by demographics. Multivariate analysis examining the relationship between knowledge and barriers after controlling for demographics revealed no significant differences. CONCLUSION: Pharmacists have limited knowledge of health literacy. We suggest training programs designed to address poor knowledge, interpreter services, access to written information tailored for various reading grade levels, and minimizing functional barriers such as time constraints.

Consumer Perceptions of a Shingles Infograph Intervention and Vaccination Plans in Community Pharmacy Settings.

Background: Cost and lack of knowledge are key barriers to improving shingles vaccination rates in community pharmacies. A health literacy (HL) tailored infograph intervention addressing these barriers can enhance consumer interest in shingles vaccinations. Objectives: The objectives were to: 1) design a health literacy tailored shingles infograph addressing cost and knowledge about vaccination barriers, 2) determine consumer perceptions of infograph usefulness, and 3) determine factors associated with shingles vaccination plans. Methods: An infograph addressing the study objectives, and a 22-item self-administered questionnaire assessing shingles vaccine awareness, HL, infograph usefulness, and vaccination plans were designed. The infograph was pilot tested with pharmacists and two community-based focus groups. Inclusion criteria consisted of age-eligible consumers at one chain and three independent community pharmacies. Consenting participants first reviewed the infograph and then completed the survey. Descriptive statistics and multivariable logistic regression analyses were performed. Results: Of the 422 eligible consumers approached, 112 participated in the study, with 55.4% from the chain pharmacies. Participants were female (56%), white (94%), between 50-70 years old (77%), had adequate HL (96%) and aware of the shingles vaccine (87%). While only 8% of the respondents considered vaccinating on the survey date, 46% considered it in the future, and 29% planned to in the next six months. The infograph was useful (90%) in recognizing vaccination need, was readable (95.5%), and understandable (96%). Consumers who found the infograph useful were significantly more likely to have vaccination plans (OR= 4.06, CI: 1.37 - 11.9, p=0.016). Conclusion: A shingles vaccine infograph focused on key barriers to vaccination was well-received and useful in promoting consumers' vaccination plans.

The Report of the 2021-2022 Professional Affairs Standing Committee: Resource Guide for the Integration of Clinical Pharmacy Faculty in Professional Practice Settings.

The 2021-22 Professional Affairs Committee was charged to (1) Develop a resource guide for member institutions and faculty regarding payment for the practice-related activities of pharmacy faculty; (2) Nominate at least one person for an elected AACP or Council Office; and (3) Consider ways that AACP can improve its financial health. This report describes the methodology and content utilized for the development of an online resource guide for member institutions, faculty, and practice sites regarding the integration of clinical faculties' patient care services into patient care settings, including models for payment and value-based payment structures that can be utilized to support the practice-related activities of faculty. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Identifying aspects of pharmacists' attitudes and barriers toward health literacy: a factor analytic study.

BACKGROUND: Health literacy has gained prominence since the Institute of Medicine Report publicized the widespread prevalence of low health literacy. Pharmacists play an important role in enhancing health literacy as a result of their proximity to patients. Literature about pharmacists' perceptions and barriers in incorporating health literacy interventions is lacking. OBJECTIVE: To develop an instrument to measure pharmacists' attitudes and barriers toward health literacy. METHODS: A survey instrument assessing attitudes and barriers was designed based on a pharmacist focus group. The instrument was pretested among a sample of pharmacists from Illinois. The final instrument was administered to a systematic sample of 1500 pharmacists who were members of the Illinois Pharmacists Association. Dillman's 5-step total design method was followed to maximize survey responses. Exploratory principal components analysis with varimax rotation was performed on attitudes and barriers items to identify underlying components. Internal consistency of the components was determined using the Cronbach α and corrected item-total correlations. RESULTS: Overall, usable responses were received from 701 respondents, yielding a 48.1% response rate. Exploratory principal components analysis of the attitudes subscale produced a 5-factor solution that explained 55.87% of the variance. The 5 components included (1) low health literacy (LHL) situations, (2) LHL reasons, (3) LHL patient characteristics, (4) medication-related factors, and (5) LHL patient-interaction factors. The barriers subscale produced 3 components: (1) practice-related barriers, (2) knowledge and interaction-related barriers, and (3) process barriers, all of which explained 53.74% of the variance. Cronbach α values for the 5 attitudes subscales ranged from 0.33 to 0.78 and, for the 3 barriers, subscale values ranged from 0.56 to 0.71, offering evidence of internal consistency. CONCLUSIONS: Identification of components of pharmacists' attitudes and barriers toward health literacy will be useful to managers interested in incorporating health literacy interventions in their practice.

Design and evaluation of a mobile serious game application to supplement instruction.

BACKGROUND AND PURPOSE: Pharmacy students often exhibit minimal interest in pharmacy management courses. This pilot study reports on the design and testing of a mobile game application (app) prototype to improve student engagement and learning of financial management concepts. EDUCATIONAL ACTIVITY AND SETTING: A mobile app (Planet Finance) was designed to supplement instruction for two key financial management topics. The app was introduced to students in two schools of pharmacy after content on financial management was taught. Students were requested to use the game app for a minimum of two weeks and complete a questionnaire assessing their knowledge of management content and perceptions of the app. FINDINGS: The overall survey response rate was 41%. The majority of respondents played the game app two to four times (48.3%). Only 13.8% of respondents completed all 10 levels. Participants generally agreed that game instructions were clear, and that the game was easy to navigate, entertaining and made learning fun; allowed more engagement with content; and enhanced financial statements and ratios comfort. Those who played the game app more often had more favorable perceptions. User data from the game app showed that the majority of respondents accessed the game app on not more than two days (89.1%) and played up to four levels (69.6%). SUMMARY: Overall, students enjoyed playing Planet Finance; however, uptake of the app was low. Future revisions may involve adding additional competitive features, content, levels, incentives, and focusing on strategies to incorporate the game into traditional classroom instruction.

Inclusion of Health Disparities, Cultural Competence, and Health Literacy Content in US and Canadian Pharmacy Curriculums.

Objective. To determine how US and Canadian pharmacy schools include content related to health disparities and cultural competence and health literacy in curriculum as well as to review assessment practices.Methods. A cross-sectional survey was distributed to 143 accredited and candidate-status pharmacy programs in the United States and 10 in Canada in three phases. Statistical analysis was performed to assess inter-institutional variability and relationships between institutional characteristics and survey results.Results. After stratification by institutional characteristics, no significant differences were found between the 72 (50%) responding institutions in the United States and the eight (80%) in Canada. A core group of faculty typically taught health disparities and cultural competence content and/or health literacy. Health disparities and cultural competence was primarily taught in multiple courses across multiple years in the pre-APPE curriculum. While health literacy was primarily taught in multiple courses in one year in the pre-APPE curriculum in Canada (75.0%), delivery of health literacy was more varied in the United States, including in a single course (20.0%), multiple courses in one year (17.1%), and multiple courses in multiple years (48.6%). Health disparities and cultural competence and health literacy was mostly taught at the introduction or reinforcement level. Active-learning approaches were mostly used in the United States, whereas in Canada active learning was more frequently used in teaching health literacy (62.5%) than health disparities and cultural competence (37.5%). Few institutions reported providing professional preceptor development.Conclusion. The majority of responding pharmacy schools in the United States and Canada include content on health disparities and cultural competence content and health literacy to varying degrees; however, less is required and implemented within experiential programs and the co-curriculum. Opportunities remain to expand and apply information on health disparities and cultural competence content and health literacy content, particularly outside the didactic curriculum, as well as to identify barriers for integration.

Demographic and health-related predictors of proton pump inhibitor (PPI) use and association with chronic kidney disease (CKD) stage in NHANES population.

BACKGROUND: Reports of adverse outcomes with use of Proton Pump Inhibitors (PPIs) and recent associations between PPI use and Chronic Kidney Disease (CKD) suggest the need to examine PPI use in the general population. OBJECTIVES: The purpose of this study was to examine PPI use in the general U.S. population with a focus on CKD stages. METHODS: This was a retrospective database study of the National Health and Nutrition Examination Survey (NHANES) for years 2009-2013. Inclusion criteria were age ≥ 18 years and having a serum creatinine value. The Andersen Behavioral Model of Health Services Utilization and previous research were used to identify the independent variables. Dependent variable was self-reported prescription medication use. Multinomial logistic regression models were used to examine factors associated with PPI use. RESULTS: Overall, the weighted prevalence of PPI use was 8.7%. Only 4.5% of the sample had stage 3 or 4 CKD. PPI use was highest among whites (10.5%) compared to minorities. PPI users were significantly older (mean = 59.8years), with a majority (80%) being 50 years and over. In multivariate analyses, PPI use was associated with having two or more comorbidities (OR = 3.8, CI: 2.85-5.13), and having fair/poor health (OR 4.6 (3.5-5.9). Stage 3 and 4 CKD patients had higher odds of using PPIs (stage 3 OR = 3.8 CI: 2.5-5.8, stage 4 OR = 6.5 CI: 1.6-25.8) compared to stage 1 patients. CONCLUSION: /Relevance: This is the first study to examine both predictors and racial disparities in PPI use in the general US population. While PPI use was low, there were racial disparities in PPI use. Multiple comorbid conditions, lower quality of life, and stage 3/4 CKD were associated with PPI use. Awareness of these predictors will enable clinicians to target key patient groups for tailored education and closer monitoring of PPI use.

Health literacy and kidney disease: toward a new line of research.

Health literacy has been recognized as an important public health issue over the past decade. Low health literacy is a widespread problem in the general population, affecting over 90 million Americans. A growing body of research has demonstrated the association between low health literacy and worse health outcomes in a variety of chronic conditions. Despite the increasing prevalence of chronic kidney disease (CKD) and the considerable interest in health literacy, there has been limited research examining the role of health literacy in individuals at all stages of CKD. This article examines the role of health literacy in kidney disease by reviewing early research on the topic, providing a conceptual model of the relationship between health literacy and health outcomes, and highlighting potential areas for future research on health literacy in CKD.

Pharmacy in an Improved Health Care Delivery Model Using Maslow's Hierarchy of Needs.

Our objective is to suggest a revised model of health care delivery that emphasizes human connections in patient care and describes the role of pharmacists within the model. Improving the quality of patient experiences is one of the triple aims of health care delivery. Using the patient-centered medical home (PCMH) model as the basis, we describe an enhanced delivery model that adopts Maslow's hierarchy of needs and addresses the current deficiencies of the PCMH model. The model envisions the creation of "community centers for engagement" that employ patient care advocates and health care practitioners who work together in an interdisciplinary manner to improve the quality of patient care experiences. Pharmacists' roles in these centers of engagement are outlined based on Maslow's hierarchy of needs. The model aims to enhance patient-provider interactions and allow pharmacists to play a pivotal role in meeting patients' needs with the goal of developing a self-actualized patient.

Mental Health Literacy of Pharmacy Students Compared to Nursing and Medical Students.

OBJECTIVES: To determine and compare the mental health literacy of pharmacy, nursing, and medical students. METHODS: Pharmacy, nursing, and medical students in the final year of their didactic program were administered a widely used mental health literacy questionnaire either via paper (nursing) or via email (pharmacy and medicine). For email questionnaires, weekly reminder emails with links for survey completion were sent over a three-week period. The questionnaire consisted of a vignette describing either depression or schizophrenia followed by items about helpfulness of a variety of interventions, medications, and activities. Depression and schizophrenia versions of the questionnaire were randomly administered to respondents in the three programs such that respondents received either male (John) or female (Jane) versions of the vignettes. RESULTS: A total of 161 out of 253 potential students responded to the survey (63.6% response rate). Majority of the respondents were female (75%), white (84.6%), had currently or in the past year interacted with people diagnosed with mental disorders (90%), and had multiple opportunities for exposure to mental health content in their coursework (49%). While a majority of respondents in all three programs correctly identified the vignettes as either depression (87%) or schizophrenia (73%), depression was identified correctly by a greater percent of those in pharmacy (88.5%) and nursing (88.4%), and schizophrenia was identified by a greater percent in medicine (82%). However, there were no significant differences by program type for correct identification of vignette. Helpfulness of various interventions, medications, and activities did not differ significantly for the depression vignette. Two significant differences by program type were noted for the schizophrenia vignette. A larger percent (72%) of nursing students perceived antidepressants as helpful for schizophrenia as compared to pharmacy (55%) and medical (18%) students. Students from all three programs responded similarly to the question on likely prognosis for those with depression/schizophrenia, both with and without professional help (p>0.01). CONCLUSIONS: Majority of students in each discipline were able to correctly identify patients with depression or schizophrenia and have similar levels of mental health literacy. The profile of responses suggest that pharmacy and nursing students were more clear about helpfulness of interventions for depression, than for schizophrenia. Given the extent of the problem of mental health, additional and continuously reinforced training on mental health throughout the four-year curriculum is necessary for first line providers such as pharmacists, nurses, and physicians.

Cannabis Dependence or Abuse in Kidney Transplantation: Implications for Posttransplant Outcomes.

BACKGROUND: Cannabis is categorized as an illicit drug in most US states, but legalization for medical indications is increasing. Policies and guidance on cannabis use in transplant patients remain controversial. METHODS: We examined a database linking national kidney transplant records (n = 52 689) with Medicare claims to identify diagnoses of cannabis dependence or abuse (CDOA) and associations [adjusted hazard ratio (aHR) with 95% upper and lower confidence limits (CLs)] with graft, patient, and other clinical outcomes. RESULTS: CDOA was diagnosed in only 0.5% (n = 254) and 0.3% (n = 163) of kidney transplant recipients in the years before and after transplant, respectively. Patients with pretransplant CDOA were more likely to be 19 to 30 years of age and of black race, and less likely to be obese, college-educated, and employed. After multivariate and propensity adjustment, CDOA in the year before transplant was not associated with death or graft failure in the year after transplant, but was associated with posttransplant psychosocial problems such as alcohol abuse, other drug abuse, noncompliance, schizophrenia, and depression. Furthermore, CDOA in the first year posttransplant was associated with an approximately 2-fold increased risk of death-censored graft failure (aHR, 2.29; 95% CL, 1.59-3.32), all-cause graft loss (aHR, 2.09; 95% CL, 1.50-2.91), and death (aHR, 1.79; 95% CL, 1.06-3.04) in the subsequent 2 years. Posttransplant CDOA was also associated with cardiovascular, pulmonary, and psychosocial problems, and with events such as accidents and fractures. CONCLUSIONS: Although associations likely, in part, reflect associated conditions or behaviors, clinical diagnosis of CDOA in the year after transplant appears to have prognostic implications for allograft and patient outcomes. Recipients with posttransplant CDOA warrant focused monitoring and support.