The Journal of the American Pharmacists Association honors Svarstad’s paper exploring effective interventions for Black patients with hypertension

By Susan Lampert Smith

It’s great to win the American Pharmacists Association’s Wiederholt Prize, which honors the best social, economic, and administrative sciences paper published during the past two years in the Journal of the American Pharmacists Association (JAPhA). But to win it three times? Earning this year’s award makes Bonnie Svarstad the Tiger Woods of the Wiederholt Prize.

Her latest winning paper looks at a successful pharmacist intervention that improved patient adherence to medication regimens and clinical outcomes in Black patients with hypertension. With her colleagues, Svarstad, emeritus professor in the University of Wisconsin–Madison School of Pharmacy’s Social and Administrative Sciences Division, led a mediation analysis of their previous TEAM (Team Education and Adherence Monitoring) clinical trial, which also won a Wiederholt Prize in 2014.

The original TEAM trial was funded by the National Institutes of Health and kicked off in 2004. This cluster-randomized clinical trial followed 576 Black patients with uncontrolled hypertension from 28 community pharmacies across Wisconsin for a six-month intervention and 12-month follow-up. Half of the pharmacies continued to offer patients standard care, while the other pharmacies offered six brief visits with a pharmacist and pharmacy technician who received TEAM training, a portable blood pressure counseling station, and novel tools to identify and reduce barriers to medication adherence for Black patients with uncontrolled hypertension.

In previous publications, Svarstad and her colleagues documented significant and sustained improvements in patient adherence to their medication regimen, blood pressure outcomes, and cost-effectiveness. In her latest winning paper, Svarstad — along with UW School of Nursing Professor Roger Brown and Brown University School of Public Health Professor Theresa Shireman — conducted a mediation analysis to identify the key mediators or intervention components that had the largest effect on patient adherence. Pharmacists’ use of the TEAM tools for identifying and reducing patient-perceived barriers to adherence and a seven-day pill box were the two interventions responsible for most of the improvement.

“We showed that pharmacists can have a strong positive effect on refill adherence by using our TEAM tools for identifying what a patient’s concerns are and, working within the scope of their practice, addressing those concerns,” Svarstad says.

Bridging sociology and pharmacy

Svarstad first came to UW–Madison as a graduate student in the highly ranked Department of Sociology. She did her master’s level work with Professor Marshall Clinard who inspired her interest in sociological theories of deviant behavior. For her PhD degree, she worked with Professor David Mechanic, who directed one of the first National Institute of Mental Health (NIMH) training programs in a new field called “medical sociology.”

“Professor Mechanic and the NIMH training program got me interested in how social sciences can help understand how patients and health professionals communicate, and how that affects health behavior and outcomes,” Svarstad says. 

Following her UW coursework, she worked as a medical sociologist doing her PhD research study at the Martin Luther King Jr. Health Center serving poor and underserved Black and Puerto Rican patients in the Southeast Bronx.

It was one of the senior medical anthropologists at the MLK center who encouraged Svarstad to conduct one of the first observational studies of physician-patient communication and patient adherence with their medication regimens.  

Svarstad’s PhD research documented wide variability in physician-patient communication, with some physicians achieving better patient adherence to medication regimens than others. Her interaction with MLK center patients, physicians, and a clinic pharmacist contributed to her career-long interest in health disparities, pharmacists’ potential role in patient consultation, and the need for better theories and easy-to-use tools for measuring and improving patient adherence and hypertension control in underserved populations. 

When she started her work, only two papers had been published in this area. Today, she says there have been nearly 175,000 papers on patient adherence, and it remains a major health problem in elderly and underserved communities.

“I say that my time in the Southeast Bronx changed my career,” she says. “It gave me a reason to do research, my raison d’etre.”

Around the time she was finishing her dissertation, Svarstad said the UW–Madison School of Pharmacy was examining new roles for the pharmacist in patient communications and invited her to give a talk about her Bronx research. She was offered a pharmacy faculty position in 1975 and became one of the first sociologists hired by a school of pharmacy in the country.

Development of communication tools and lab

In addition to her TEAM studies, Svarstad helped develop the School’s social and administrative sciences curriculum, including the School’s required PharmD lab course on pharmacist-patient communications, which hires actors to play the role of patients. She also collaborated with Betty Chewning, professor in the School’s Social and Administrative Sciences Division, in the development and validation of a novel self-report tool called the Brief Medication Questionnaire (BMQ).

Their BMQ was first published in 1999, is now one of the most widely cited tools for screening or measuring patient adherence and barriers to adherence, and played a major role in Svarstad’s NIH-funded TEAM studies. For her early work on the BMQ and her health collaboration model, Svarstad won the American Pharmacists Association (APhA) Research Achievement Award in Economic, Social, and Administrative Sciences in 1988 and the Pinnacle Award in 2004.

Svarstad is already looking forward to her next paper, which she hopes to write with Chewning, reflecting on their team’s development of the BMQ tool, and all the ways it has been used in the past 25 years, internationally and here in the United States, to measure and improve patient adherence and better health.  

Svarstad’s record-setting third win of the Wiederholt Prize marks the sixth earned by School of Pharmacy faculty. The prize itself, in fact, is named after the late Joseph Wiederholt, a former professor and colleague of Svarstad’s at the School of Pharmacy — and the award’s first recipient.

“My pharmacy colleagues and I helped develop the field of social and behavioral pharmacy at UW,” says Svarstad, who says that coming to UW–Madison was “the best career decision I could have ever made.”