School of Pharmacy UNIVERSITY OF WISCONSIN - MADISON Current Research Faculty in the Division of Social and Administrative Sciences in Pharmacy are engaged in numerous and diverse research activities. Major faculty-led projects currently in progress are described briefly below. Collectively, these projects represent the breadth and depth of scholarship within the Division and indicate the diverse topics, theories, and methods that are addressed. While specific projects illustrate the research streams of individual faculty members, together they reflect the highly collaborative nature of SAS research activities. Most projects are carried out by research teams composed of several division faculty members and graduate students; many also involve colleagues on the Madison campus, in other U.S. universities, and in other countries. Each project description identifies the specific faculty member(s) who may be contacted for further information about that project. Aggregate Demand Index Barriers faced by caregivers managing older adults’ medications in rural areas Clustering Adherence Behavior among Patients with Type 2 Diabetes Development of a Patient-Driven Education Program to Support the Use of Pharmacy Quality Rating Comparison Tools A Documentary History of American Pharmacy Estimating Statin Adherence and Patient Beliefs after an Initial Cardiovascular Event Exploring factors influencing asthma related emergency department visits among adults Impact of the Affordable Care Act’s contraceptive coverage guarantee Improving Medication Adherence among African American Patients with Type 2 Diabetes Improving Over-the-Counter Medication Safety for Older Adults Key to the Medicine Chests: The Pharmaceutical Trade in Philadelphia in the Era of Lewis and Clark Mercury: From Medicine to Menace Moderator Effect of Health Literacy, in the Relationship between Patient Illness and Medication Beliefs, and Medication Adherence Older Adults & Drug Decisions: Collaboration & Outcomes Pharmacist Compensation Survey Physician Referral for Pharmacist MTM Services Transplant medication adherence and patient outcomes Aggregate Demand Index (ADI) (Dave Kreling, investigator) This project is an ongoing monthly project to collect and disseminate data on the demand for pharmacists in the U.S. that is funded by the Pharmacy Workforce Center. A panel of individuals representing organizations that hire pharmacists on a direct and regular basis report their perceptions of the supply and demand balance in the market for pharmacists. Barriers faced by caregivers managing older adults’ medications in rural areas (Kevin Look) This study has the following specific research aims: (1) to map the processes of how younger and older caregivers manage medications for their older adult care recipients in rural areas, (2) to identify perceived barriers within each step of the caregiver medication management process and examine successful strategies that have been used to overcome these barriers. Clustering Adherence Behavior among Patients with Type 2 Diabetes (Olayinka Shiyanbola) The objectives of this study is to: (1) classify patients’ medication adherence behavior with oral diabetes medications based on their beliefs in medicines and illness perceptions, and (2) to describe the characteristics of the patients in each cluster based on psychosocial variables such as patient’ self-efficacy, clinical, and sociodemographic characteristics. Based on Horne’s necessity-concerns framework and the Extended Self-regulatory Model, this study uses an exploratory technique, cluster analysis to cluster patients into groups based on their beliefs. Personalized interventions developed based on patient clusters may lead to improved adherence and health outcomes. Development of a Patient-Driven Education Program to Support the Use of Pharmacy Quality Rating Comparison Tools (Olayinka Shiyanbola) This collaborative project with investigators at the University of Cincinnati-Ana Hincapie (PI), University of Arizona, and the Pharmacy Quality Alliance aims to apply direct choice experiment techniques to identify the relative importance of multiple pharmacy quality measures on patient’s pharmacy choice; and pilot an educational program that enhances patient understanding of pharmacy quality and motivates patients to use pharmacy quality information. Preliminary studies from Olayinka Shiyanbola (see Pubmed Link) show that if patients are going to be able to make informed decisions on which pharmacy to visit based on publicly reported quality information, they need to understand what pharmacy quality means. To align and prioritize efforts aimed at educating patients on pharmacy quality and the use of pharmacy quality rating reports, we evaluate the relative relevance of different pharmacy quality metrics (e.g., Centers for Medicare & Medicaid Services (CMS) star ratings, patient experience surveys) on patient choice. A Documentary History of American Pharmacy (Gregory Higby) This project will pull together a book-length collection of letters, speeches, laws, articles, and chapters that document the historical development of pharmacy in the USA. Each will be placed in context with an appropriate introduction and necessary commentary. Estimating Statin Adherence and Patient Beliefs after an Initial Cardiovascular Event (Olayinka Shiyanbola) Together with Elizabeth Unni (PI) at Roseman University, and SelectHealth, an integrated managed care organization in Utah, this PhRMA foundation funded research aims to identify whether statin medication adherence changes after a cardiovascular event such as a heart attack/stroke, and if it declines, to examine patients’ beliefs about statins and their cardiovascular disease. A matched historical cohort study design using commercial health plan data from SelectHealth will be used to determine the effect of the occurrence of a first cardiovascular event on statin adherence. A cross-sectional survey study design will be used to examine patient beliefs in statins and cardiovascular disease after they experience a cardiovascular event. Identifying and understanding the possible changes in adherence and the reasons for the change may lead to better solutions for care providers who want to help patients reduce the risk of a future cardiovascular event. Exploring factors influencing asthma related emergency department visits among adults (Kevin Look) This study uses path analysis to explore potential mediators for asthma-related emergency room visits in adults based on the Andersen’s Model of Health Care Utilization. Racial differences in asthma-related emergency department visits are also being explored. Impact of the Affordable Care Act’s contraceptive coverage guarantee (Kevin Look) The goals of this project were to evaluate the impact of the Affordable Care Act’s (ACA) young adult insurance expansion on the utilization of and expenditures for contraceptive medications and related health services. Improving Medication Adherence among African American Patients with Type 2 Diabetes (Olayinka Shiyanbola) This project, funded by a 3 year NIH KL2 Career Development Award, aims to culturally adapt an illness perception questionnaire that assesses African American/Black beliefs about type 2 diabetes. Based on the self-regulatory model and a mixed methods approach, we will utilize focus groups, cognitive interviews, and survey administration to develop a valid and reliable tool useful in identifying modifiable illness beliefs among African Americans/Blacks. This study sets the stage for the development and testing of an intervention that modifies patient beliefs and improves medication adherence among African American/Blacks with type 2 diabetes. Improving Over-the-Counter Medication Safety for Older Adults (Michelle Chui) Adverse drug events (ADEs) associated with over-the-counter medications cause 178,000 hospitalizations each year, older adults, aged 65+ are particularly vulnerable to these ADEs. Working in a multidisciplinary team with members from pharmacy, nursing, public health, engineering, and medicine this project aims to refine the system redesign intervention and implementation strategy through diagnostic and formative evaluation, to evaluate the effectiveness of a refined system redesign intervention on preventing misuse of high-risk OTC medications by older adults, and to evaluate the implementation of a refined system redesign intervention in community pharmacies. Key to the Medicine Chests: The Pharmaceutical Trade in Philadelphia in the Era of Lewis and Clark (Gregory Higby) A short version of this invited paper was presented in November 2004 at a conference on the medical aspects of the Lewis and Clark expedition. The full published version will examine the contents of the two medicine chests carried by the Corps, illuminating the unique position of Philadelphia in the early American drug trade. Mercury: From Medicine to Menace (Gregory Higby) For 250 years, mercury and its compounds were among the most consumed medicines in the Western cultures. Debates about mercury and its use in medicines have been in the forefront of therapeutic change and controversy beginning in the early 1800s. This project will explore these issues historically. Moderator Effect of Health Literacy, in the Relationship between Patient Illness and Medication Beliefs, and Medication Adherence (Olayinka Shiyanbola) This study aims to determine if health literacy has a moderator effect on the relationship between beliefs in medicines and illness perceptions in regards to medication adherence. A cross-sectional survey administered to adult patients taking oral diabetes medications in two family medicine clinics will examine patient self-reported adherence, illness perceptions, beliefs in medicines and health literacy. For patients with limited health literacy, it is not known if simply improving patients’ belief in the need for the medication (often provided by pharmacists educating patients on medicines) may lead to improved medication adherence. This study helps to further investigate this question. Older Adults & Drug Decisions: Collaboration & Outcomes (Betty Chewning, investigator, collaborating with Betsy Sleath at the University of North Carolina) This NIH-funded project continues a research stream examining patient health behaviors, perspectives and partnerships with health care providers. The goal of this study is to evaluate a computerized assessment and printout of patients’ visit agendas designed to cue more complete discussion of patient priorities at a clinic visit. Through a longitudinal, randomized controlled trial involving 20 physicians and 500 patients, the study is evaluating the impacts of this intervention on the patient-provider interaction, patient pain levels, and health quality of life. Data from of this project and the Patient Roles in Arthritis Management project are being used to help operationalize the concept of concordance in patient-provider encounters for individuals who have chronic conditions. Pharmacist Compensation Survey (Dave Mott and Dave Kreling, investigators) Surveys of pharmacists in Wisconsin provide ongoing data for trending pharmacist employment, salaries, work hours, and work activities. These data have been collected on a continuous, biennial basis since 1977, allowing extended trend analyses of economic and workforce parameters for pharmacists in Wisconsin. Physician Referral for Pharmacist MTM Service (Dave Kreling and Betty Chewning, investigators) Working in tandem with David Hahn (from the Wisconsin Research and Education Network, a practice-based physician network) are conducting this pilot project funded by the Community Pharmacy Foundation to develop, implement, and evaluate processes and tools for physicians to refer patients to pharmacists for medication management services. In each of four Wisconsin cities, a physician-centric approach is being used with a physician-pharmacist dyad to define a set of distinct pharmacist service activities so patients can be referred by their physician to the pharmacist for the services. The pharmacist services and referral procedures and processes developed for the project will be evaluated from the perspectives of the physicians, pharmacists, and patients, with an eye toward expanding the referrals in other physician and pharmacist practices. Transplant medication adherence and patient outcomes (Kevin Look) The purpose of the project is to determine the relationship between medication adherence and transplant rejection, graft loss, and patient death in a large cohort of transplant recipients. This project will also evaluate the impact of specialty pharmacy management on out-of-pocket medication costs and patient outcomes in transplant recipients.