Health Outcomes and Services Research


PI -F. Ellen Loh, BPharm, PhD, MBA, Assistant Professor, Social, Behavior & Administrative Sciences

Successful treatment of disease with prescription medication requires use of the medication as prescribed. However, research has shown that medications are commonly not used as directed. Medication nonadherence is a major health care problem, with studies showing that high rates of nonadherence related to poor clinical outcomes, high health care costs, and lost productivity. Dr. Loh has conducted studies to investigate the issue of medication nonadherence in patients with diabetes and to examine if good medication adherence would translate into cost-savings for payers and whether or not eligibility for Medicare Part D medication therapy management should be based on medication adherence. In these studies, she found that there was a significant and positive correlation between the percentage of patients with optimal adherence and percentage with diabetes under control; however, medication adherence was suboptimal in patients with diabetes in general. She also found that high adherence to guideline-recommended drug therapy reduces medical costs and produced net savings for Medicare beneficiaries with diabetes enrolled in Part D plans; however, the Medicare Part D medication therapy management criteria were not optimally targeted to capture underuse of and poor adherence to guideline-recommended evidence-based medications for prevalence chronic diseases in the elderly.

Stuart B., Shen X., Quinn C., Brandt N., Roberto P., Loh F.E., Hendrick F., Kim C., Huang X., Rajpathak S. Proximal Predictors of Discontinuance with Oral Antidiabetic Agents among the Elderly. Journal of Managed Care Pharmacy. 2016;22(9):1019-27.

Tan E., Yang W., Pang B., Dai M., Loh F.E., Hogan P. Geographic Variation in Antidiabetic Agent Adherence and Glycemic Control among Patients with Type 2 Diabetes. Journal of Managed Care Pharmacy. 2015;21(12):1195-1202.

Stuart B., Dai M., Xu J., Loh F.E., Shoemaker J.S. Does Good Medication Adherence Really Save Payers Money? Medical Care. 2015;53(6):517-23.

Stuart B., Loh F.E., Miller L., Roberto P.N. Should Eligibility for Medication Therapy Management Be Based on Drug Adherence? Journal of Managed Care Pharmacy. 2014;20(1):66-75.

Medication Adherence: Behavioral and Psychological Factors

PI -Elizabeth Unni, PhD, MBA, BPharm, Chair and Associate Professor, Social, Behavior & Administrative Sciences

Within the context of chronic disease self-management by patients, Dr. Unni utilizes the behavioral theories and focuses on the behavioral and psychosocial aspects of medication adherence. Her work examines the influence of factors such as patient’s beliefs in their medications and illnesses and health literacy in improving medication adherence and developing interventions based on these factors. Understanding the significance of communication, a part of her work is on patient-provider communication and the impact of this communication, including the patient education materials, in influencing medication adherence. She is also interested in the measurement of medication adherence and has created a self-reported medication adherence scale which is validated in various chronic disease conditions. Her work continues to refine the scale in different disease conditions with different populations and settings. Dr. Unni is an expert on survey methodology and qualitative methods in data collection and analysis.

Unni, E.J., Sternbach, N., Goren, A. Using the Medication Adherence Reasons Scale (MAR-Scale) to identify the reasons for non-adherence across multiple disease conditions. Patient Preference and Adherence, 13, 993-1004 (2019).

Unni, E.J., Wagoner, E.V., Shiyanbola, O.O. Utilizing a 3S (Strategies, Source, and Setting) approach to understand the patient’s preferences when addressing medication non-adherence in patients with diabetes: A focus group study in a primary outpatient clinic. BMJ Open, 9(1), e024789 (2019).

Moya, A., Unni, E.J., Montuoro, J., Desselle, S.P. Engaging pharmacy technicians for advanced clinical support tasks in community pharmacies: A cluster analysis. Journal of the American Pharmacists Association, 59, S32-S38 (2019).

Shiyanbola, O.O., Pigarelli, D.W., Unni, E.J., et al. Design and rationale of a mixed methods randomized control trial: ADdressing Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve diabetes outcomes. Contemporary Clinical Trials Communications, 14, 100326 (2019).

Schwartz, J.K., Unni, E.J. Letter by Schwartz and Unni Regarding Article, “Ethnic Differences in 90-Day Post stroke Medication Adherence”. Stroke, (2019). DOI: 10.1161/STROKEAHA.119.026521

Unni, E.J., Gabriel,S., Ariely, R. A review of the use and effectiveness of digital health technologies in asthma patients. Allergy, Asthma, & Immunology, 121, 680-691 (2018).

Shiyanbola, O.O., Unni, E.J., Huang, Y., Lanier, C. Utilizing the Extended Self-Regulatory Model to Characterize Diabetes Medication Adherence: A Cross-Sectional Study. BMJ Open, 8, e022803 (2018). DOI: 10.1136/bmjopen-2018-022803.

Rose, T., Unni, E.J., Jones, G. Factors Influencing Nutrition Label Reading Behavior in Individuals with Selected Chronic Diseases. American Journal of Health Education, 49(4) (2019). DOI: 10.1080/19325037.2018.1486756

Shiyanbola, O.O., Unni, E.J., Huang, Y., Lanier, C. The association of health literacy with illness perceptions, medication beliefs, and medication adherence among individuals with type 2 diabetes. Research in Social and Administrative Pharmacy, (2017). pii: S1551-7411(17)30686-1. DOI: 10.1016/j.sapharm.2017.12.005.

Unni, E.J., Sharp, L. Giving adherence intervention programs their due. Accepted for publication with Current Medical Research & Opinion, 11, 1 (2017). 2DOI: 10.1080/03007995.2017.1356709