Michelle A Chui

University of Wisconsin–Madison | UW · Division of Social and Administrative Sciences

BACKGROUND The increase of people with complex chronic health conditions is stressing the U.S. healthcare delivery system. Community pharmacies play a role in ensuring patients’ safe medication use for chronic care management, but their efforts are undermined by volatile work demands and other system barriers. OBJECTIVE This study seeks to concept...

Objectives Older adults’ (ages ≥65) inappropriate over-the-counter medications (OTC) use is prevalent, comprising Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Given that pharmacies sell many OTCs, structurally redesigning pharmacy aisles for improving patient safety (Senior Safe) was conceived to mitigate older adult OTC misuse, using S...

In Wisconsin, opioid use disorder (OUD) is highly prevalent among individuals impacted by the criminal justice system. Medications for opioid use disorder (MOUD), including injectable naltrexone, are crucial for treating OUD and especially important for individuals transitioning out of correctional facilities and back into the community. Unfortunat...

Medications for opioid use disorder (MOUD), including injectable naltrexone, are a key component in the treatment of opioid use disorder (OUD). These medications are especially important for individuals transitioning out of correctional facilities and back into their communities, as individuals receiving MOUD are 85% less likely to die due to drug...

Background and Objectives Older adults (≥65 years) are the largest consumers of over-the-counter (OTC) medications and exceptionally vulnerable to the risks of these medications, including adverse drug events (ADEs). However, little is known about how older adults select and use OTCs. This is the first multi-site study designed to prospectively qua...

Introduction: Community pharmacies, as unique and accessible healthcare venues, are ideal locations to implement interventions aiming to improve patient care. However, these interventions may increase workload or disrupt workflow for community pharmacists, technicians, and other staff members, threatening long-term sustainment. There are growing ca...

Medications for opioid use disorder (MOUD) are especially important for formerly incarcerated individuals with opioid use disorder (OUD) and can reduce the risk of re-arrest and overdose during community reentry. Unfortunately, few formerly incarcerated individuals are able to access MOUD within the community, missing a critical tool for rehabilita...

Background Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with...

Introduction: The increase of people with complex chronic health conditions is stressing the U.S. healthcare delivery system. Community pharmacies play a role in ensuring patients’ safe medication use for chronic care management, but their efforts are undermined by volatile work demands and other system barriers. Methods: This study seeks to concep...

Background Medication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing...

Background US Veterans are four times more likely to be diagnosed with chronic obstructive pulmonary disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based...

Objective: Clinical decision support systems (CDSS) were implemented in community pharmacies over 40 years ago. However, unlike CDSS studies in other health settings, few studies have been undertaken to evaluate and improve their use in community pharmacies, where billions of prescriptions are filled every year. The aim of this scoping review is t...

Over-the-counter (OTC) medications are products that have been made easily accessible to allow patients to treat common ailments without a prescription and the cost of a doctor’s visit. These medications are generally considered safe; however, there is still a potential for these medications to lead to adverse health outcomes. Older adults (ages 50...

Introduction to the problem: Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents...

Introduction: Community retail pharmacists are experiencing unsafe levels of stress and excessive demands within the workplace. One aspect of workload stress that has been overlooked among pharmacists is occupational fatigue. Occupational fatigue is a characteristic of excessive workload including increased work demands and reduced capacity and re...

Background: The medication prescribing, and de-prescribing process is complex with numerous actors, organizations, and health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy’s dispensing platform, theoretically improvi...

Background U.S. Veterans are four-times more likely to be diagnosed with Chronic Obstructive Pulmonary Disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-bas...

Background: Designing clinical decision support (CDS) tools is challenging because clinical decision-making must account for an invisible task load: incorporating non-linear objective and subjective factors to make an assessment and treatment plan. This calls for a cognitive task analysis approach. Objectives: The objectives of this study were t...

Safe over the counter (OTC) medication use by older adults (OAs, aged 65+) is difficult to achieve because of age-related physiologic complexities, and millions of OAs in the US who are at risk of experiencing a major adverse drug event linked to an OTC medication. Our interdisciplinary team studies how we can improve OTC safety in OAs by developin...

Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients a...

Introduction: The Senior Section is a continuation of a previous intervention that aims to address a gap in medication safety, specifically related to older adult selection and use of over-the-counter medications. The purpose of this paper is to describe the protocol of this study. Methods: This study will occur in three phases: an adaptation ph...

Abstract Background Prescription opioid misuse is a serious national crisis; in 2018 the top drugs involved in prescription overdose deaths included pain medications (opioids), benzodiazepines, and stimulants. Health information technology (health IT) provides a means to address this crisis through technologies that streamline the prescribing and d...

Introduction When patients are seen in an ambulatory outpatient clinic, such as their primary care provider's office, the prescriber often stops or discontinues medications. Although medication discontinuations are documented in the clinic's health record, this information may not be communicated to the pharmacy. Within the last decade, CancelRx ha...

Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human work performance and wellbeing in sociotechnical systems. HFE in pharmacy involves the human-centered design of systems to support individuals and teams who perform medication-related work. We define the scope of HFE methods in...

This chapter introduces hierarchical task analysis (HTA), a data analysis method borrowed from cognitive engineering that can be applied to carefully gathered data from scenario-based, think-aloud interviews with subject matter experts, and/or detailed observations in the field. The first half of the chapter outlines the origins of HTA, what HTA is...

Deprescribing is the process of withdrawing or replacing medications to improve outcomes and reduce medication-associated risks. Deprescribing, though traditionally the domain of healthcare professionals, is now receiving attention from human factors experts. In turn, the deprescribing community is gaining an appreciation for human-centered design...

Background Adults aged 65+ (older adults) disproportionately consume 30% of over-the-counter (OTC) medications and are largely responsible for making OTC treatment decisions because providers lack awareness of their consumption. These treatment decisions are complex: older adults must navigate age-related body/cognitive changes, developed comorbidi...

Background Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. Objective To review select HFE methods well s...

Objective Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic’s electronic health record (EHR) to the outpatient pharmacy’s software. The objective of this s...

Background No interventions have attempted to decrease misuse of over-the-counter (OTC) medications for adults older than 65 (older adults) by addressing system barriers. An innovative structural pharmacy redesign (the Senior SectionTM) was conceptualized to increase awareness of higher-risk OTC medications. The Senior Section contains a curated se...

Background Qualitative and mixed methods approaches are commonly used to understand participants’ interactions with real-world settings and can help health services researchers to obtain realistic details about patients’ health behaviors. However, interviews do not easily capture data about how patients perform health-related behaviors that are not...

Only 1-in-70 high-risk patients receive a naloxone prescription despite of an increase in naloxone prescribing since 2017. Prescribing rates remain low despite clear guidelines to co-prescribe naloxone to high-risk patients. Prescribing rates are disproportionately low among certain provider specialties. A common strategy used to increase naloxone...

Objective: To assess how controlled substance medication discontinuations were communicated over time Data Sources: Secondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation. Study Design: The study utilized a...

The potential risks of over-the-counter (OTC) medications are often aggravated in vulnerable populations, such as older adults. The elevated patterns of older-adult OTC medication use do not necessarily translate into a greater understanding of these medications or their safety implications. The objective of this study was to assess how older adult...

Older adult selection and use of over-the-counter (OTC) medications is informed by a range of motivations and rationales-forming different older adult personas. Holden et al. (2019) categorized older adults seeking OTC medications into two personas: habit followers and deliberators. The goal of this paper is to 1) operationalize and expand on the p...

Using a work domain analysis and complementary thematic analysis, this paper aims to describe medication management work, its constraints, and complexities from the perspectives of family caregivers of children with medical complexity—a medically fragile segment of the pediatric population often dependent on multiple and complex medication regimens...

Background The Quadruple Aim recognizes that caring for the healthcare employee is necessary to optimize patient outcomes and health system performance. Although previous research has assessed pharmacists' workload, this study is the first to describe pharmacist occupational fatigue—a characteristic of excessive workload that inhibits workers’ abil...

The 2019-2020 AACP Research and Graduate Affairs Committee (RGAC) was charged with articulating the case for and evaluating the state of implementation science in academic pharmacy, given the potential for implementation science to act as a driver of practice and curricular transformation. Based on the current state of pharmacy research in this are...

Background For older adults, health risks from inappropriate use of over-the-counter (OTC) medications represent a prevalent clinical and public health challenge. Focus groups with pharmacists led to the identification of a number of systems barriers to pharmacists supporting the safe selection and use of OTC medications by this population. Such fe...

Background and Objectives: Over-the-counter (OTC) medication use has increased safety risks for adults older than 65. Most older adults purchase OTC medications from community pharmacies, where the considerable distance or visual obstructions between the prescription area and OTC aisles undermine pharmacists’ ability to assist patients with OTC med...

Objectives: This pilot study examines effectiveness of an innovative pharmacy design change on over-the-counter (OTC) medication misuse in older adults (ages over 64). Few interventions have attempted to decrease older adult OTC misuse, and none have addressed system barriers. A structural redesign of the pharmacy (the Senior Section) was conceptua...

Background and objectives: Despite their availability without prescription, OTC medications pose a risk for significant harm for older adults due to higher likelihood of polypharmacy, drug interactions, and age-related physiological changes. The purpose of this study is to identify the individual decision factors that influence how older adults se...

Pharmacy practice-based research networks (PBRNs) are relatively new compared to their primary care forebears, representing a unique set of research challenges. Recruitment and retention of network members are essential to maintaining the integrity of the network and achieving its research goals. Many studies have evaluated recruitment and retentio...

Objective: This study used an innovative information-gathering approach to provide insight into the nature and structure of pharmacy staff encounters with patients seeking over-the-counter (OTC) medications and revealed specific activities of pharmacy staff around these encounters. Methods: A multistep process was used to develop and standardize...

OBJECTIVES/SPECIFIC AIMS: This study aims to describe factors impacting older adult OTC selection and use so they can be targeted with a community pharmacy intervention to improve older adult medication safety. The primary outcome is the characterization of the relationship between health literacy, risk perception, and OTC misuse. These results wil...

The Quadruple Aim is a concept that attempts to improve the health of the population while optimizing the health system performance. The Quadruple Aim recognizes that caring for the healthcare employee is a prerequisite to optimizing patient outcomes and health system performance—attributing excessive expectations of health care professionals to in...

This study supports the tenants of the Quadruple Aim by focusing on the well-being of a unique health care professional, the pharmacist. The PCA, EFA, and resulting two-factor structure suggest an abbreviated, 7-item survey to capture the components underlying pharmacist fatigue and can be used and validated in future research as a tool to measure...

Medication list inconsistencies between outpatient clinics and community pharmacies lead to medication dispensing errors and potential adverse drug events. CancelRx is a new functionality that electronically sends a medication cancellation order from the clinic’s electronic health record (EHR) to the pharmacy’s dispensing software—potentially reduc...

Background: Interruptions constitute a key part of the communication strategy for healthcare providers, including community pharmacy personnel. Previous research in other healthcare environments has shown that interruptions are very common and may present as patient safety hazards. One 1999 study, conducted in community pharmacy settings, found th...

Background: Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory design (PD), a method that utilizes the involvement of patients and other stakeholders, is well-suited for the design of multifaceted interventions in complex work systems,...

Background: Medication errors are estimated to cost $42 billion in annual global treatment costs. Pharmacy-based Patient Safety Organizations (PSO) are tasked with collecting and analyzing incidents, near misses, and unsafe condition reports as one way of engaging pharmacies in quality improvement efforts. Collectively, these reports are referred...

Although studies have assessed pharmacists’ workload, no research exists to describe pharmacist occupational fatigue—a characteristic of excessive workload that inhibits workers’ abilities to function at normal capacity. This area is crucial as evidence suggests that nurse occupational fatigue can negatively impact patient safety. The objectives of...

When recruiting Economic, Social, and Administrative Sciences researchers for industry or academia positions, the ideal candidates are often ones with dual Doctor of Pharmacy (PharmD) and Doctor of Philosophy (PhD) degrees. These individuals have rigorous research training combined with clinical expertise and knowledge of the United States Healthca...

The purpose of this study was to develop a survey that will describe occupational fatigue in pharmacists

Objective: To describe challenges associated with the medication use process and potential medication safety hazards in an Ethiopian hospital emergency department using a human factors approach. Methods: We conducted a qualitative study employing observations and semi-structured interviews guided by the Systems Engineering Initiative for Patient S...

Objective: Medication errors are common in community pharmacies. Safety culture is considered a factor for medication safety but has not been measured in this setting. The objectives of this study were to describe safety culture measured using the Agency for Healthcare Research and Quality (AHRQ) Community Pharmacy Survey on Patient Safety Culture...

Medication errors in the ambulatory setting are common and contribute to significant morbidity and mortality. Given the Institute of Medicine’s recommendation of adopting a systems-based approach to improving medication safety, research has been conducted utilizing human factors and ergonomics conceptual frameworks, approaches, and methods to study...

Objectives: The aims of the study were to characterize handoffs in community pharmacies and to examine factors that contribute to perceived handoff quality. Methods: A cross-sectional study of community pharmacists in a Midwest State of the United States. Self-administered questionnaires were used to collect information on participant and practi...

Background: Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medi...

Background: The Centers for Medicare & Medicaid Services (CMS) adopted the proportion of days covered (PDC) calculation for use in their Five-Star Quality Rating System for Medicare Advantage and Prescription Drug Plans. This calculation uses the prescription adjudication date (i.e., date the prescription is billed to the benefits manager by a pha...

Electronic prescribing, commonly referred to as e-prescribing, has been introduced to many outpatient settings to reduce medication errors and facilitate prescription processing. E-prescribing allows prescribers to electronically generate and send e-prescriptions to pharmacies. Federal government requirement for meaningful use of electronic health...

Background: The Centers for Medicare & Medicaid Services (CMS) include measures of medication adherence within its Medicare Part D star ratings program. These adherence measures have motivated the development of new methods to improve patient adherence. Automatic prescription refill programs in community pharmacies are an intervention that has see...

Objectives: To determine the effect of an automatic prescription refill program on the prescription pickup lag in community pharmacy. Design: A post-only quasi-experimental design comparing automatic and manual refill prescription cohorts for each of the 3 Centers for Medicare and Medicaid medication adherence metrics. Setting: A 29-store comm...

Background: Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. Objectives: The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have mu...

Background: Older adults are the largest consumers of over the counter (OTC) medications. Of the older adults who are at risk of a major adverse drug event, more than 50% of these events involve an OTC medication. Objective: To explore how older adults select and hypothetically use OTC medications and if the selected medications would be conside...

Background: National community pharmacy organizations have been redesigning pharmacies to better facilitate direct patient care. However, evidence suggests that changing the physical layout of a pharmacy prior to understanding how the environment impacts pharmacists' work may not achieve the desired benefits. This study describes an objective meth...

The U.S. Agency for Healthcare Research and Quality (AHRQ) developed a hospital patient safety culture survey in 2004 and has adapted this survey to other healthcare settings, such as nursing homes and medical offices, and most recently, community pharmacies. However, it is unknown whether safety culture dimensions developed for hospitals can be tr...

Objectives: It has been reported that supportive personnel, such as pharmacy technicians, are key participants in the use of health information technology. The purpose of this study was to describe how pharmacy technicians use e-prescribing and to explore the characteristics of technicians that support pharmacists in ensuring patient safety. Meth...

Objectives: To describe older adult patients' perceptions and experiences with e-prescribing; and to explore the impact of e-prescribing on patient care, including patient-provider communication. Methods: Seventy-five participants' aged 50 and older and living within one hour of Pittsburgh, Pennsylvania, completed a telephone survey that include...

Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct i...

To explore barriers and facilitators to recovery from e-prescribing errors in community pharmacies and to explore practical solutions for work system redesign to ensure successful recovery from errors. Cross-sectional qualitative design using direct observations, interviews, and focus groups. Five community pharmacies in Wisconsin. 13 pharmacists a...

Multiple reports from the Institute of Medicine and the National Academy of Engineering, (IOM 2001; Reid et al., 2005; Kaplan et al., 2013) have called for the use of human factors engineering (HFE) and systems engineering principles and methods/tools to improve health care delivery. Yet, the integration of engineers into health care settings and t...

Objective To elicit and describe mutually agreed upon common problems and subsequent solutions resulting from a facilitated face-to-face meeting between pharmacists and physicians. Design Descriptive, exploratory, nonexperimental study. Setting Wisconsin from October to December 2011. Participants Physicians and community pharmacists. Intervent...

The use of e-prescribing is increasing annually, with over 788 million e-prescriptions received in US pharmacies in 2012. Approximately 9% of e-prescriptions have medication errors. To describe the process used by community pharmacy staff to detect, explain, and correct e-prescription errors. The error recovery conceptual framework was employed for...

Purpose of the Study: To elicit the thought process or mental model that community pharmacists use when making recommendations on over-the-counter (OTC) medications to older adults and to elicit the current practices of community pharmacists in providing information, advice, and counseling to older adults about potentially inappropriate OTC medicat...

To examine factors influencing the amount of time and information pharmacy personnel provide to patients at drive-through and walk-in counselling areas. On-site observational data collection in 22 community pharmacies by pharmacy students. Information included observable patient characteristics such as gender, age range, English proficiency and mob...

Background: Unsafe medication use represents a major public health concern, especially for older adults. OTC medications, those that can be purchased without a formal prescription or advice from a health care professional, are one contributor to unsafe use because of their perceived safety and accessibility. Despite the recognition of pharmacists’...

Workload has been described both objectively (e.g., number of prescriptions dispensed per pharmacist) as well as subjectively (e.g., pharmacist's perception of busyness). These approaches might be missing important characteristics of pharmacist workload that have not been previously identified and measured. To measure the association of community p...

Objective To characterise the safety hazards related to e-prescribing in community pharmacies. Methods The sociotechnical systems framework was used to investigate the e-prescribing technology interface in community pharmacies by taking into consideration the social, technical and environmental work elements of a user's interaction with technology....