Michelle Chui, associate professor and vice chair of the Social and Administrative Sciences Division of the School of Pharmacy, received a $1.5 million grant from The Agency for Healthcare Research and Quality (AHRQ) to develop, implement, and evaluate an intervention in community pharmacies to improve over-the-counter (OTC) medication selection and use by older adults. Adverse drug events (ADEs) associated with OTC medications cause 178,000 hospitalizations each year, representing a major patient safety concern. Older adults, aged 65+, one of AHRQ’s priority populations, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk of a major ADE, more than 50% were because of concurrent use of an OTC and prescription medication. However, no effective interventions have attempted to decrease harm associated with OTC medication use in this population. Chui’s project proposes to implement and evaluate a system redesign intervention to decrease high-risk OTC medication misuse. This intervention will reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the store’s physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult’s health status. Chui’s hypothesis is that older adults who are more aware of risks and can more easily determine if that risk pertains to their own health situation by speaking with a community pharmacist will be more knowledgeable in their OTC selection, which will in turn lead to safer OTC use. Chui outlined specific aims of the project to include:

• refining the system redesign intervention and implementation strategy through diagnostic and formative evaluation.
• evaluating the effectiveness of a refined system redesign intervention on preventing misuse of high-risk OTC medications by older adults.
• evaluating the implementation of a refined system redesign intervention in community pharmacies.

The study will be conducted in three mass-merchandise stores with onsite pharmacies. The study is significant and innovative. A highly experienced and multidisciplinary team comprised of members from pharmacy, nursing, public health, engineering, and medicine will be utilizing human factors engineering theories and methods to design and implement a patient-centered intervention, and be partnering with a community pharmacy committed to improving health, wellness, and self-care in its communities. An agency within the U.S. Department of Health and Human Services, ADRQ’s mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the Department and with other partners to make sure that the evidence is understood and used. The three-year project is funded via an R18 mechanism focused on System Redesign to Improve Medication Safety. Chui’s research interest include elevating the standard of community pharmacy practice and providing tools to practitioners in ambulatory settings.