By Katie Ginder-Vogel

Two new assistant professors are joining the UW–Madison School of Pharmacy’s Social and Administrative Sciences (SAS) Division and the Sonderegger Research Center this year: Olufunmilola Abraham and James (Jay) Ford.

• Abraham comes to the UW–Madison School of Pharmacy from the University of Pittsburgh School of Pharmacy, where she served as an assistant professor. Her research has focused on improving medication adherence and patient safety for adolescent and young adult patients.
• Ford, who was an associate scientist and principal investigator at the UW–Madison College of Engineering’s Center for Health Systems Research, studies how health systems engineering tools and techniques can be used to more effectively implement organizational change.

“Jay Ford and Funmi Abraham will give our Sonderegger Research Center at the School of Pharmacy a critical mass for the development of major, multi-investigator research projects designed to address important problems in health care,” says Steven Swanson, dean of the UW–Madison School of Pharmacy.

Olufunmilola Abraham

Wiederholt Prize winner, pediatric pharmacy innovator

Olufunmilola Abraham is the first researcher to look at gamification for medication use and has built two video games that teach kids about medication safety and how to communicate effectively with their pharmacists, doctors, and nurses. As an assistant professor at the University of Pittsburgh, she is currently evaluating a new program with Pittsburgh school and youth development programs, in which student pharmacists visit schools to teach children about the responsible use of over-the-counter medications.

Abraham earned her PhD at UW–Madison and was Michelle Chui’s first graduate student.

“There’s no one in the School of Pharmacy that focuses on pediatric research, so she’s really breaking new ground for us,” says Michelle Chui, associate professor and vice chair of the Social & Administrative Sciences Division, and director of the School’s Sonderegger Research Center.

“She has the opportunity to build a lab and mentor grad students, and from my perspective, that’s fantastic. I mentored her, and now she’ll mentor others.”

Abraham uses many engineering concepts and frameworks in her research with a unique focus on pediatric and adolescent medication safety, particularly for young patients with cystic fibrosis, a disease that used to be deadly for children but, thanks to evolved treatments, has become more of a chronic illness that eventually young people can be responsible for managing themselves.

“I focus on improving medication adherence and patient safety for adolescents and young adults,” says Abraham. “This is an area where typically we haven’t done a lot of patient-based research in pharmacy.”

As medical advances have made it possible for children with serious chronic conditions, such as cystic fibrosis, to manage them with medications, the consumption of over-the-counter (OTC) and prescription medication by children under 18 years old has become comparable to that of adults.

“Do the techniques we use for older people work for kids?” asks Abraham. “Or do we need to revise how we teach children about safe and responsible use of medicines, mental health, and overall well-being, and how pharmacists can partner with them?”

Abraham began looking into this question when she received funding from the Community Pharmacy Foundation three years ago to observe the impact of pharmacists’ communication with children and their parents when providing prescribed medications. The research she published about her findings in the Journal of the American Pharmacists Association (JAPhA) was awarded the 2018 Wiederholt Prize from the American Pharmacists Association.

“There’s no one in the School of Pharmacy that focuses on pediatric research, so [Dr. Abraham is] really breaking new ground for us.”
–Michelle Chui

Named in honor of the first recipient, UW–Madison faculty member Joseph B. Wiederholt (1949-2001), the prize recognizes the best pharmacy-related paper published in the JAPhA in the area of Economic, Social, and Administrative Sciences.

“The prestigious Wiederholt Prize is a signal of the quality of the research that Dr. Abraham conducts. She really strengthens our group here at the School of Pharmacy,” says Dave Mott, professor and chair of the Social & Administrative Sciences Division.

“Dr. Abraham’s focus on adolescent medication use using engineering principles provides a unique and important approach to identifying and solving problems that adolescents have using medication,” says Mott.

Gamification of medication safety

One of her findings, that kids and teens are interested in learning about their medication from pharmacists via interactive and educational technologies, inspired her to develop two video games in the past year. One, almost fully developed, teaches children how to use over-the-counter medications safely and how to talk with their pharmacists and health care providers. The second, Cystic FiBlaster, which is in the early stages of prototype development, teaches young patients with cystic fibrosis how to work with their pharmacists to take their medications regularly. Cystic FiBlaster won the award for best game at the University of Pittsburgh’s Games4Health competition.

“Young patients with cystic fibrosis sometimes have really poor medication adherence, so there’s a need for pharmacists to play a bigger role in their lives and help them take their medications as prescribed,” explains Abraham. “They can play the game and realize how their medications improve their lung and organ function and their quality of life, and the game prompts them to talk with their pharmacist and their health care provider about their medication.”

Abraham plans to continue working on educational games at UW–Madison.

“UW has been one of the schools that has done a lot with gaming, but medication gaming research is understudied,” says Abraham. “I don’t think anyone in the country is looking at gamification for medication use, so I’m excited to help UW–Madison and the School of Pharmacy become leaders in that area.”

Connecting pharmacists with young patients

In her previous work evaluating the OTC medication safety program with Pittsburgh school and youth development programs, in which student pharmacists work with children, Abraham says the biggest surprise was the positive impact the program had on the student pharmacists, in addition to the schoolchildren, their parents, and teachers.

“A lot of our pharmacy curriculum, at schools around the country, teaches student pharmacists to educate older people, so this was a practical, experiential, impactful way to teach them about medication use in children—and also care for children,” says Abraham.

“I don’t think anyone in the country is looking at gamification for medication use, so I’m excited to help UW–Madison and the School of Pharmacy become leaders in that area.” –Olufunmilola Abraham

The program is currently being evaluated, and the schools and youth development sites have requested it continue. Abraham is wrapping up a paper about the project and hopes to implement a similar program in Wisconsin.

“I’ve been thinking deeply about that and talking to faculty,” says Abraham. “You need a lot of connections and manpower to pull it off, but it’s the kind of program that impacts the community and pharmacy training and has huge benefits.”

Good things come from Madison

Abraham, who grew up in Nigeria and completed her doctorate at the UW–Madison School of Pharmacy, has deep personal ties to UW—she met her husband when they were both graduate students at the university, and both her mother-in-law and father-in-law earned advanced degrees from UW–Madison. She says she’s coming back to UW–Madison for the people and the university itself.

“I’ve lived in Nigeria. I’ve lived in the U.S. I’ve traveled and I have to say that the people in the School of Pharmacy are some of the most honest, genuine people of integrity that I’ve found,” says Abraham. “That’s what I’m most excited about—to be part of a collaborative, supportive research community, with people who are also personable and intelligent.”

Abraham was one of three UW–Madison PhDs hired as assistant professors at the University of Pittsburgh in a two-year period. Soon after she joined the faculty at Pitt, she remembers a colleague saying, “Only good things come from Madison.” Abraham says she really appreciates UW–Madison’s prestige.

“The School of Pharmacy has trained so many leaders who are impacting the field of pharmacy all over the country,” says Abraham. “I’m super fortunate to be able to come back as a faculty member and continue my career development at UW–Madison, where there’s a strong support system for faculty.”

“I’m most excited to be part of a collaborative, supportive research community.” –Olufunmilola Abraham

At Pittsburgh, Abraham helped start the School of Pharmacy’s PhD program in Pharmaceutical Outcomes and Policy Research; served on the PhD committee of an industrial engineering graduate student who was applying engineering techniques to improve community pharmacy; and mentored professional pharmacy students and School of Public Health Master’s students.

“I’m looking forward to taking on more PhD students,” says Abraham. “One of the reasons I’m excited to return to Madison is because UW’s PhD program in this line of research is over 60 years old.”

Abraham just submitted a letter of intent to the UW Institute for Clinical and Translational Research to start collecting preliminary data to conduct similar cystic fibrosis research in Wisconsin, and Abraham is on the lookout for new funding for gamification and medication use research.

“I hope to bring my passion and excitement to branch out to this pediatric/young adult demographic and do groundbreaking work in this area,” says Abraham. “I have had success working with community partners and PharmD students to get them involved in research and help them understand how research impacts patient care and pharmacy practice. I’m hoping to bring that to UW–Madison and further grow the School of Pharmacy’s PhD program from my experience at a different institution.”

Jay Ford

Leading health care change with an engineering approach

Jay Ford spent the last 17 years as an associate scientist and permanent principal investigator at UW–Madison’s Center for Health Systems Research and Analysis in the College of Engineering, before deciding to take the leap to a tenure-track faculty position in the School of Pharmacy.

“At the back of my mind, I’ve always wanted to try to teach somewhere,” Ford says. “I settled into research, but when I saw the opening for this position, I thought it was a really good fit for my skill set.”

The position called for individuals with research experience focused on health systems improvement, stakeholder/participant engagement, and dissemination and implementation. Ford’s research has focused on the latter two, and he has worked in health systems improvement for the past 30 years.

“I also noticed that they were looking for the ability to interact with other academic disciplines, and I realized that I already had active and prior collaborations with individuals in many of these disciplines,” says Ford. “In talking with others before applying for the job, I learned that my experience in behavioral health, as well as long-term care, might be strengths that I could bring.”

As Ford went through his interview process, he was struck by how at ease he felt.

“I had the strong sense that I would fit in with the faculty in the Social & Administrative Sciences Division, bringing both complementary and uniquely different skills,” he says. “I always felt welcome and like I could be a valuable part of the team. That’s been there through the entire process and confirmed that this was the right decision at the right time.”

An engineer’s perspective on health care

Ford brings an outside perspective on health care issues and how pharmacy is involved in health care.

“I’m coming at this as a health systems engineer, not a pharmacist,” says Ford. “I’m coming from the perspective of dissemination, implementation, and sustainment of changes. It’s really important when you implement a change that people are able to sustain those changes. I think it’s an important perspective that is not always represented in pharmacy schools.”

Michelle Chui, chair of the search committee, who also serves as vice chair of SAS and director of the School’s Sonderegger Research Center, sought different aspects of diversity in the search.

“Having an engineer will help us to challenge some of [our] paradigms and make us a stronger group in thinking about collaboration.” 
–Michelle Chui

“When we engaged in the faculty search, I was pushing to hire one individual who was not a pharmacist, because pharmacists come from a particular paradigm, and having an engineer will help us to challenge some of those paradigms and make us a stronger group in thinking about collaboration, research, and approaches to research,” says Chui. “All those things will really strengthen our group.”

Chui plans to bring Ford into the Sonderegger Research Center to help strengthen the center’s emphasis on medication use research within the broader health care system.

“He’s done a lot of work in substance abuse, which is interesting, because our group has started to develop grants related to the opioid crisis, so his arrival is very timely,” says Chui.

Using health systems engineering tools to implement change

Ford uses health systems engineering tools and techniques to implement organizational change and teaches staff at long-term care centers, behavioral health organizations, and community resource centers to use health systems engineering best practices. That makes it easier for staff to adapt those tweaks to other aspects of the organization that need help down the road.

“I’m trying to understand how we can integrate health systems engineering principles with a quality improvement approach,” Ford says. “One of my projects takes that approach to try to impact inappropriate antibiotic prescribing.”

That project, a collaboration with Chris Crnich, chief of medicine at the Madison VA Hospital and associate professor of medicine in the Division of Infectious Diseases at UW–Madison’s School of Medicine and Public Health, helps nursing home staff examine their work processes and implement changes related to pre- and post-prescribing of antibiotics. Another project aims to help AIDS patients engage in treatment to become virally suppressed, via the implementation of a motivational interview intervention in AIDS service organizations.

A third project in its 14th year is a partnership with a UW-developed network for addiction improvement, NIATx, which started by helping behavioral health organizations implement simple changes to improve access to and retention in treatment utilizing PDSA rapid change cycles.

“I’m trying to understand how we can integrate health systems engineering principles with a quality improvement approach.” –Jay Ford

“Now, we’re trying to get them to implement more complex changes, using models for clients who have both substance abuse and mental health issues,” Ford explains. “People who go to community-based substance abuse treatment providers are often put into treatment silos and don’t get concurrent treatment for mental health and substance abuse.”

Ford envisions a scenario similar to that of visiting a primary care doctor, in which a patient can get an exam, a flu shot, lab work, and even specialized scan, all at once. Many large health care organizations are moving toward this more comprehensive model, and simple internal changes can often be all it takes to get there, such as applying for a license to deliver mental health services and hiring a licensed staff member who can bill for mental health services within the organization.

“A local organization like Tellurian would do an assessment of both substance use and mental health issues, and if they identified mental health issues, they’d have staff who could help with that and with substance abuse issues,” explains Ford. “Then, the patient could continually go to Tellurian for both, rather than just Tellurian for substance abuse and Journey Mental Health for mental health.”

Systems approach for falls prevention among seniors

Ford also works on preventing older adults from falling, a major public health issue that affects one-third of all people over the age of 65 and where Wisconsin has one of the highest rates of death from unintentional falls in the nation. Ford recently completed a project with Jane Mahoney, a professor in the UW School of Medicine and Public Health, on implementation strategies to help Wisconsin’s aging and disability resource centers host more Stepping On workshops for older adults at risk for falling.

“Now, we’re looking at falls in assisted living, and we just had a paper accepted in the Journal of Applied Gerontology that led to the development of a flowchart of fall prevention systems that details the types of falls happening in assisted living,” says Ford.

As a result of this ICTR funded work, Ford’s team at the Center for Health Systems Research and Analysis added new questions about fall risk assessment and interventions to the online quarterly reporting system of WCCEAL, the Wisconsin Coalition for Collaborative Excellence in Assisted Living, and they have a year’s worth of data describing what assisted living communities are doing for fall prevention and interventions.

“We’ll look at the data and talk about what is happening with falls risk assessment,” says Ford. “We’ll publish some papers to identify opportunities for intervention, to help them focus more on this and reduce falls in assisted living.”

New directions

Ford plans to continue collaborating with Dr. Crnich on two new projects in Wisconsin Nursing Homes and is looking to expand research on antibiotic prescribing into assisted living communities in Wisconsin. He is already talking with a colleague at the APT Foundation in New Haven, Connecticut, about a new research idea related to opioid prescribing.

“I’m excited about two things: forming new collaborative relationships to work on new issues and being able to mentor students coming through the School of Pharmacy’s SAS graduate program,” says Ford, who has coached hundreds of behavioral health organizations across the country on how to implement change. “One of my next great milestones will be when I’ve mentored that first student through a graduate program.”

“I’m excited about two things: forming new collaborative relationships to work on new issues and being able to mentor students.” –Jay Ford

Ford plans to hire grad students slowly, in order to find the right mix of people.

“I want to build the right team for what I’m doing, going forward,” he says. “There will be a learning curve, and to some extent, I’ll be learning with them. Hopefully, they’ll be as patient with me as I will be with them.”

Ford credits his wife, a clinical nutritionist, and his three children—a freshman at UW–Platteville, a daughter who works in Madison, and a daughter who works for the Amigos program in Houston—with providing him the support necessary to make this type of career leap.

“I’m making a move at a point in my career that absolutely would not be possible without a supportive family, so it’s great that my wife is very supportive, and my children are very supportive, and have been since I embarked on this journey,” Ford says. “I don’t think any of this would be possible without their support.”

Learn more about the School of Pharmacy’s Social & Administrative Sciences Division.