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Opioid use disorder (OUD) is highly prevalent among jail and prison populations in the United States, including in Wisconsin. Medications for opioid use disorder (MOUD), including long-acting injectable naltrexone, are crucial in the treatment of OUD. These medications are especially important for individuals transitioning out of jail or prison and back into the community. Unfortunately, few individuals who were formerly incarcerated continue MOUD after reentry due to a variety of barriers. Wisconsin community pharmacists are highly accessible and uniquely positioned to provide care for this population, specifically by administering injectable naltrexone. However, community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated has not been previously explored. As a first step, this legislative and regulatory review aimed to identify Wisconsin statutes and administrative codes that may impact these services for this population. Two legal databases were searched to identify relevant Wisconsin statute and administrative code subsections. Overall, 24 statute subsections (from 7 chapters) and 31 administrative code subsections (from 12 chapters) were identified that (1) highlighted a need or potential role of community pharmacist-administered injectable naltrexone for individuals who were formerly incarcerated or (2) served as a potential barrier or facilitator to the availability, access, or use of these services. Future work should focus on helping community pharmacists leverage available resources and overcome existing legal barriers to providing or supporting MOUD services. Importantly, work should be done to ensure that individuals who were formerly incarcerated can be linked to these services upon reentry.

Background Measuring intervention fidelity can help justify the transition of evidence-based practices into everyday community-based practices by helping identify components of the intervention supporting the intervention’s uptake. Current methods to measure fidelity include self-reported data, observational data using audio or video recordings, and in-vivo observations, but these are limited due to cost-ineffectiveness, time inefficiency, and external validity threats. Photo coding is proposed as a new, pragmatic method of observational data to measure intervention fidelity, as was used in a pharmacy system re-design intervention (Senior Safe™) to improve over-the-counter (OTC) medication safety for older adults. Methods Guided by human factors engineering principles, Senior Safe re-shelved OTC medications based on safety level, and signage was added to designate safer and high-risk products. Senior Safe was implemented by pharmacy leadership and maintained by pharmacy staff. Pharmacy leadership and researchers collaborated to take photos of Senior Safe two times (Time 1 and Time 2), at least three months apart, to examine intervention layout and medication categorization fidelity. A Layout Codebook was constructed to evaluate the conformity of signage to ergonomic principles. A Medication Categorization Codebook was designed to assess whether the signage was properly allocated to the designated products. Two research assistants and two PharmD students coded the photos. A fidelity standard of ≥ 80% concordance with intervention guidelines was used to signify high-fidelity. Results Fidelity was assessed within 67 pharmacy sites implementing Senior Safe. All sites achieved ≥ 80% fidelity concordance between Time 1 and Time 2 for the Layout Codebook. Alternatively, for the Medication Categorization Codebook, 97% of sites met high-fidelity standards during Time 1, compared to 85% of sites at Time 2, indicating statistically significant negative drift. Overall, over half of all Time 1 and Time 2 concordance rates involving the Layout and Medication Categorization Codebooks exceeded the ≥ 80% high-fidelity standard. Conclusion Measuring intervention fidelity is useful in determining whether interventions are sustained and successfully transitioned into community-based practice. Photo coding is an innovative approach to measure intervention fidelity and allows researchers to identify multiple layers of concordance and discordance to intervention guidelines. Organizations are encouraged to investigate intervention fidelity, including identifying discordance and adaptation needs.

Clinical and Translational Research (CTR) requires a team-based approach, with successful teams engaging in skilled management and use of information. Yet we know little about the ways that Translational Teams (TTs) engage with information across the lifecycle of CTR projects. This qualitative study explored the challenges that information management imposes on the conduct of team-based CTR. We conducted interviews with ten members of TTs at University of Wisconsin. Interviews were transcribed and thematic analysis was conducted. TTs' piecemeal and reactive approaches to information management created conflict within the team and slowed scientific progress. The lack of cohesive information management strategies made it more difficult for teams to develop strong team processes like communication, scientific coordination, and project management. While TTs' research was hindered by the institutional challenges of interdisciplinary team information sharing, TTs who had developed shared approaches to information management that foregrounded transparency, accountability, and trust, described substantial benefits to their teamwork. We propose a new model for the Science of Team Science field - a Translational Team Science Hierarchy of Needs - that suggests interventions should be targeted at the appropriate stage of team development in order to maximize a team's scientific potential.

Community pharmacists can play an important role in patient safety by consulting patients on over-the-counter (OTC) medications. Several OTC counseling frameworks have been integrated into pharmacy education to guide pharmacists through these consultations, but limited work has been performed to examine how these frameworks are applied in real-world settings. The objective of this study was to identify the topics discussed during over-the-counter medication consultations and explore how they align with existing counseling frameworks. Participants were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select OTCs for self-treatment. The selection process and potential interactions with pharmacy staff were recorded via Tobii Pro Glasses 2. Deductive and inductive content analysis of the recordings were used to compare participant–pharmacist consultations to existing OTC counseling frameworks. In total, 144 participants completed the study, with 32 (22%) having an OTC consultation with the pharmacist. Across all consultations, eight topic categories were identified. The consultations most frequently focused on discussions of product details and did not closely align with the OTC counseling frameworks. Future work should examine if and how this discordance contributes to OTC misuse among those interacting with pharmacists and potentially adapt or develop new frameworks to further support consultations and OTC safety.

To conduct high-quality, rigorous research, and advance scientific knowledge, Translational Teams (TTs) engage in information behaviors, including seeking, using, creating, sharing, storing, and retrieving information, in ways specific to the translational context. Currently, little is known about TTs' approach to information management. This qualitative pilot study explored how TTs at the University of Wisconsin-Madison interact with information, as well as the scientific and organizational impact of their interactions. We conducted interviews with ten members of UW TTs. Interviews were transcribed and thematic analysis was conducted. Four themes emerged: (1) TT members did not recognize the centrality of information or information behaviors to their scientific work; (2) TT members engaged in similar information behaviors and used similar tools across disciplines and topics; (3) TT members did not receive support or guidance from their institution in managing information; and (4) Individualized choices of TT members conflicted at the team level, causing confusion and increasing the potential for data and information loss. Acting as , TT members made individualized decisions about what tools to use and how to use them, often in a piecemeal manner and without communicating these decisions to other team members. Research institutions should both encourage teams to discuss their information management approaches at the beginning of a project and provide leaders with training on how to have these conversations and what topics should be included. Additionally, institutions can provide researchers with guidelines for using software platforms to help mitigate information management challenges.

Abstract 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 multisite study designed to prospectively quantify the type and intended use of OTCs selected by older adults in community pharmacies where products are purchased. Research Design and Methods Older adults (n = 144) were recruited from 10 community pharmacies from a Midwestern health system. Participants were given hypothetical symptoms and asked to select one or more OTCs for self-treatment. They were asked to report how they would use the products at symptom onset and when symptoms persisted or worsened. They also reported their current medication list and health conditions. Participants’ OTC selections were evaluated for 4 types of misuse: drug-age, drug-drug, drug-disease, and drug-label. Results Of the 144 participants, 114 (79%) demonstrated at least one type of misuse when describing how they would use their OTC selections at symptom onset. Drug-drug and drug-label misuse had the highest prevalence. Overall, 26 (18%) and 28 (19%) participants showed only drug-drug or drug-label misuse, respectively. Notably, 55 (38%) of participants demonstrated misuse in 2 or more misuse categories. Misuse potential was exacerbated when participants described treating persistent or worsening symptoms. Discussion and Implications The results highlight the high prevalence and complexity of OTC misuse in older adults and the need for additional work to improve OTC safety.

In Wisconsin, opioid use disorder (OUD) is highly prevalent among individuals impacted by the criminal justice system. Medications for opioid use disorder (MOUD), which includes injectable naltrexone, are a key component in the treatment of OUD and especially important for formerly incarcerated individuals as they transition out of correctional facilities and back into their communities. Unfortunately, few formerly incarcerated individuals are able to access MOUD upon community reentry. Wisconsin community pharmacists are a promising resource for providing injectable naltrexone, as they have the legal capacity to provide injections and are more accessible than other healthcare providers. However, utilization of community pharmacist-provided injectable naltrexone by formerly incarcerated individuals remains low. Additionally, research has not explored community pharmacist-provided injectable naltrexone for formerly incarcerated individuals. As a result, Aim 1 was used to identify the barriers and facilitators to community pharmacist-provided injectable naltrexone for formerly incarcerated individuals through semi-structured interviews with five different stakeholder groups. Content analysis was to summarize barriers and facilitators based on the Socioecological Model. Overall, participants identified barriers and facilitators across all levels of the Model. Aim 2 included a legal analysis of Wisconsin statutes and administrative codes with implications for community pharmacist-provided injectable naltrexone for formerly incarcerated individuals. Aim 2 also included an environmental scan of available injectable naltrexone services in Wisconsin. Both the analysis and scan emphasized the importance of increasing the number of MOUD providers and that community pharmacists can be an important resource for formerly incarcerated individuals. The legal analysis also highlighted several statues and codes that hinder or facilitate availability of or access to community pharmacist-provided injectable naltrexone. Finally, Aim 3 included three iterative focus groups with community pharmacists. Focus groups were used to inform an intervention that improves access to community pharmacist-provided injectable naltrexone for this patient population. The final intervention included pharmacist-led educational meetings with correctional staff about community pharmacist-provided injectable naltrexone. The participants also discussed specific components of the intervention, as well as anticipated challenges/barriers. The results of this project can increase access to injectable naltrexone for formerly incarcerated individuals and improve several health and social outcomes for this patient population.

Abstract Older adults (65+) are the largest consumer of over-the-counter (OTC) medications and disproportionately prone to adverse drug events (ADEs). Despite perceptions that OTCs are generally safe, OTC misuse can lead to ADEs. However, as identified through the Consumer Health Products Association (CHPA) and Gerontological Society of America (GSA) National Summit, little is known about OTC misuse in older adults. This is the first muti-site study to prospectively quantify how older adults select OTCs in community pharmacies where products are typically purchased. Older adults (n=144) were recruited from 10 community pharmacies. Participants were given hypothetical symptoms and asked to select one or more OTCs. After selection, they were asked to report how they would use the product, their home medications, and their health conditions. OTC selections were evaluated for the following misuse categories: 1) drug-age (Beers Criteria), 2) drug-drug (interactions with home medications), 3) drug-disease (health conditions), and 4) drug-label (product’s indications and directions). At least one type of misuse was identified in 114 (79%) older adults, with 57 (40%) demonstrating misuse in >1 category. Overall, 363 total instances of misuse were identified (x̄=3.18 per participant). There was high prevalence of drug-drug and drug-label misuse, as 107 (74%) demonstrated misuse in one or both categories. The results highlight OTC misuse frequency and complexity in older adults. Knowing older adults’ OTC misuse prevalence is critical for understanding medication-associated risks and developing effective interventions. Importantly, these results are a first step toward addressing the research gaps identified by CHPA and GSA.

Abstract Older adults’ inappropriate use of over-the-counter medications (OTCs) is prevalent and comprises: (1) Drug-Age misuse – medication risks due to advanced age, (2) Drug-Drug misuse – medication interactions, (3) Drug-Disease misuse – contraindications with health conditions, and (4) Drug-Label misuse – deviations from label instructions. Since pharmacies are ubiquitous sources of OTC accessibility and medication safety expertise, a structural redesign of pharmacy aisles (Senior SafeTM) was conceived to mitigate older adult OTC misuse. A central feature of Senior Safe is the use of Stop Signs for high-risk OTCs and Behind-the-Counter Signs (BTC) for particularly high-risk OTCs. Given the signage’s practical importance, this study’ principal aim was to determine whether Senior Safe reduced misuse of Stop Sign/BTC OTCs. Twenty pharmacies from a mid-Western healthcare system were matched and randomly allocated to either control or intervention groups, from which 288 older adults were recruited (ages 65-91). Participants’ reported OTC use for a symptom scenario (pain, sleep, cough/cold/allergy) was evaluated to determine whether it fulfilled the four misuse types. Misuse occurrences between intervention/control sites were compared using multivariate modeling. Drug-Age and Drug-Drug misuse frequencies were significantly lower in intervention sites (Coef.=-1.012, p=.004; Coef.=-1.702, p=.004, respectively), while Drug-Disease and Drug-Label misuse had too few occurrences in intervention sites for statistical comparisons. Also, adults aged 85+ had the greatest likelihood of all misuse types. Senior Safe shows substantial benefit reducing high-risk OTC misuse, which is important particularly for vulnerable adults ages 85-91. Future research should document intervention mechanisms contributing to lower older adult OTC misuse.

Sargeant, a 1995 UW-Madison electrical engineering doctoral graduate, has funded a graduate fellowship that provides financial assistance to a successful African-American doctoral student in the Department of Electrical and Computer Engineering.