The Peter Lamy Center on Drug Therapy and Aging challenges established beliefs by using traditional research methods in innovative ways to advance the science in addressing medication safety for older adults.

The current focal areas include highlighting our work over the last 3 years:

Psychotherapeutic Medication Use, Quality, and Outcomes

The use of potent psychotherapeutic agents, such as antipsychotics, antidepressants, and anxiolytic agents, can help older adults manage psychiatric conditions, substance use disorders, pain, and other distressing symptoms. If inappropriately managed, however, psychotherapeutic medications can lead to increased risk of falls, trauma, sedation, and other adverse effects. We focus on the use and outcomes of psychotherapeutic medications in older adults in the community and residential settings.

Publications

Albrecht, J. S., Abariga, S. A., Perfetto, E. M., Mullins, C. D., & Rao, V. (2020). Receipt of treatment for depression following traumatic brain injury. The Journal of Head Trauma Rehabilitation.

Le TT, Park S, Choi M, Khokhar B, Wijesinha M, Simoni-Wastila L. (2020). Respiratory events associated with concomitant opioid and sedative use among Medicare beneficiaries with chronic obstructive pulmonary disease. BMJ Open Respiratory Research 2020; 7:e000483. doi: 10.1136/bmjresp-2019-000483.

Park, Siyeon, Le T. Tham, Julia F. Slejko, Ester Villalonga-Olives, and Eberechukwu Onukwugha. "Changes in Opioid Utilization Following Tumor Necrosis Factor Inhibitor Initiation in Patients with Rheumatoid Arthritis." Rheumatology and Therapy 6, no. 4 (2019): 611-616.

Schepis, T. S., Simoni‐Wastila, L., & McCabe, S. E. (2019). Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults. International Journal of Geriatric Psychiatry, 34(1), 122-129.

Resnick, B., Galik, E., Boltz, M., Holmes, S.D., Fix, S., Vigne, E., Zhu, S., & Lewis, R. (2018). Polypharmacy in assisted living and the impact on clinical outcomes. Consultant Pharmacist, 33(6), 321-330.

Presentations

Holmes, S.D., Kuzucan, A., Brandt, N., Qato, D., Zarowitz, B., Wastila, L. (Accepted). The Association of Antipsychotic Use with Care Transitions among Long-Term Care Residents. Abstract submitted to the 2020 Annual Meeting of the American Geriatrics Society.

Riggins S. (2019, November). Comparative Efficacy and Safety of Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors in Older Adults: A Network Meta-Analysis. Presentation at 2019 American Society Consultant Pharmacists Annual Meeting, Grapevine TX.

Olopoenia A, Camelo-Castillo Wendy, Simoni-Wastila Linda. (2019, August). Concurrent Use of Gabapentin, Benzodiazepines and Opioids: Prevalence and Risk Factors Among Commercially Insured United States Adults. ICPE Poster Presentation, Drug Utilization session, Philadelphia, PA.

Onasanya O, Hanna ML, Crawford T, Perfetto EM. (2019, May). Patients with Anti-Dementia Drug Use but No Documented Dementia-Related Diagnosis: How Do They Compare to Those with a Diagnosis? ISPOR, New Orleans, LA.

Tham T Le, Sean Fleming, Linda Simoni-Wastila. “Patterns of Opioid Use Among Patients with Cancer-related Pain Diagnoses”, ICPE Annual Meeting 2019.

Multi-Morbidity

Many older adults suffer more than one chronic condition. The medical complexity of seniors results in multiple medications prescribed, often resulting in poor management of both medications and conditions. But understanding medical complexity—both treated and untreated—and the unique and joint contributions of multiple comorbidities poses unique methodologic challenges. Our research focuses on these analytic difficulties, focusing on the intersection of physical and psychiatric conditions.

Publications

Chou J, Pellegrin K, Cooke C, Zarowitz B, Hanlon A, Lozano A, Brandt NJ. Understanding the Socioeconomic and Geographical Characteristics of Beneficiaries Receiving a Comprehensive Medication Review (CMR). Accepted for publication on June 3, 2020. In JMCP.

Olopoenia Abisola, Onukwugha Eberechukwu, Simoni-Wastila Linda, Camelo-Castillo Wendy, Villalonga-Olives Ester, Gandhi Aakash Bipin, Slejko Julia. Patterns of prescription opioid utilization among adolescents and adults with co-morbid chronic pain and mental health diagnosis (Under review).

Presentations

Tham T. Le, Danya M. Qato, Larry Magder, Margrét Bjarnadóttir, Zafar Zafari, Linda Simoni-Wastila. Comorbidities in Medicare Older Adults with Chronic Obstructive Pulmonary Disease. ISPOR Annual Meeting 2020, FL, USA (Meeting canceled).

Tham T Le, Sean Fleming, Ameha Aynalem, Jefffrey Chen, Linda Simoni-Wastila. Healthcare Resource Utilization and Costs in Older COPD Patients with and without Frequent Exacerbations. ISPOR Annual Meeting, May 2020.

Tham T Le, Sean Fleming, Ngan Pham, Danya M Qato, Linda Simoni-Wastila. “Burden of Chronic Obstructive Pulmonary Disease (COPD) Among Older Adult Medicare Beneficiaries in the United States”, American Geriatric Society Annual Meeting 2019.

Gressler, L., McRae, J., Bajracharya, R., Olopoenia, A., Castillo, W. C., & Qato, D. M. (2019, November). Does the Methodology to Measure Multimorbidity Matter? Assessing Measurement Techniques of Multimorbidity in Nationally-Representative Medical Expenditure Panel Survey Data. Poster presentation in APHA's 2019 Annual Meeting and Expo, Philadelphia, PA.

Chou J, Lee M, Kaminsky T, Namvar T, Cooke C, Brandt N. (2019, November). Understanding Patient Preferences Regarding Multi-Medication Packaging. Poster presentation at the 2019 American Society Consultant Pharmacists Annual Meeting, Gaylord Texan Resort and Convention Center, Grapevine, TX.

Olopoenia A, Camelo-Castillo Wendy, Simoni-Wastila Linda. (2019, August). Concurrent Use of Gabapentin, Benzodiazepines and Opioids: Prevalence and Risk Factors Among Commercially Insured United States Adults. ICPE Poster Presentation, Drug Utilization session, Philadelphia, PA.

Olopoenia A, Camelo-Castillo Wendy, Simoni-Wastila Linda. (2019, August). Patterns of Prescription Opioid Use Among Commercially Insured United States Youth and Young Adults with Co-morbid Chronic Pain and Mental Health Conditions. ICPE Spotlight poster presentation, Pediatrics session, Philadelphia, PA.

Olopoenia A, Onukwugha Eberechukwu, Simoni-Wastila Linda, Camelo-Castillo Wendy, Villalonga-Olives Ester, Gandhi Aakash, Slejko Julia. (2019, June). Patterns of prescription opioid utilization among adolescents and adults with co-morbid chronic pain and mental health diagnosis. Poster Presentation at Academy Health Meeting, Behavioral Health Services Research, Washington, DC.

OTHER POSTERS (UNDER REVIEW)
Tham T Le, Danya M Qato, Zafar Zafari, Margret Bjarnadottir, Larry Magder, Linda Simoni-Wastila. Prediction of COPD Treatment Nonadherence Using Real World Medicare Data. ICPE Annual Meeting 2020, Berlin, Germany.

PRESENTATION ABSTRACTS (UNDER REVIEW)
Tham T. Le, Linda Simoni-Wastila. Coprevalence of Comorbidities in Medicare Older Adults with Chronic Obstructive Pulmonary Disease. ICPE Annual Meeting 2020, Berlin, Germany.

Olopoenia A, Simoni-Wastila L. Prevalence of and factors associated with the chronic opioid utilization among commercially insured US adults with co-morbid chronic pain and mental health disorders. ICPE Annual Meeting 2020, Berlin, Germany.

Medication Therapy Management—Policy and Practice Implications

The Medicare Part D Medication Therapy Management (MTM) program presented significant advances in care provision to eligible Medicare beneficiaries. Through the MTM program, pharmacists or other qualified providers interact with patients, caregivers and/or their healthcare providers to ensure appropriate and safe medication use. To further understand the MTM Program, the Lamy Center has engaged in research, policy and practice initiatives to provide future directions for the MTM Program with the goal of improving patient-centred care.

Publications

Cooke, C., Chou, J., Shon, J., Barrow, M., Lee, M., Assefa, M., Alexishin, S., Brandt, N. on their comment letter “Medication Therapy Management Improvements – Standardized Format (CMS-10396/OMB control number 0938-1154)” being posted by CMS to the Public Comments section on the Federal Register webpage (Apr 28, 2020): https://www.regulations.gov/document?D=CMS-2020-0016-0016

Gray C, Cooke CE, Brandt N. Evolution of the Medicare Part D Medication Therapy Management Program from Inception in 2006 to the Present. Am Health Drug Benefits. 2019 Sep;12(5):243-51.

Tong Z, Cooke CE, Brandt NJ. Online Provision of Part D Medication Therapy Management Program Information. J Manag Care Spec Pharm. 2019 Aug;25(8):898-903. doi: 10.18553/jmcp.2019.25.8.898.

Sharma K, Cooke CE, Howard AK, Chater R, Brandt NJ. Beneficiary, Caregiver, and Case Manager Perspectives on the Medication Therapy Management Program Standardized Format. J Gerontol Nurs. 2019 Apr 1;45(4):7-13. doi: 10.3928/00989134-20190311-01.

Brandt NJ, Cooke CE, Sharma K, Chou J, Carden MJ, Kumbera P, Pellegrin K. Findings from a National Survey of Medicare Beneficiary Perspectives on the Medicare Part D Medication Therapy Management Standardized Format. J Manag Care Spec Pharm. 2019 Mar;25(3):366-391. doi: 10.18553/jmcp.2019.25.3.366.

Brandt NJ, Cooke CE. Centers for Medicare and Medicaid Services Support for Medication Therapy Management (Enhanced Medication Therapy Management): Testing Strategies for Improving Medication Use Among Beneficiaries Enrolled in Medicare Part D. Clin Geriatr Med. 2017 May;33(2):153-164. doi:10.1016/j.cger.2017.01.001. Epub 2017 Feb 14.

Presentations

Evolving opportunities for Medication Therapy Management (MTM). Presented at Seminar sponsored by the AMCP and ASCP student chapters at University of Maryland School of Pharmacy, October 22, 2019.

Johnson K, Triebwasser C, Harris I, Dowell P, Haidar T, Kiptanui Z, Bundschuh O, Harris I, Cooke C, Brandt N. The Part D Enhanced Medication Therapy Management Model: Monitoring Findings as the Model Enters Year Two. ISPE’s 35th International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE), Philadelphia, PA, August 2019.

Triebwasser C, Johnson K, Liu M, Haidar T, Dowell P, Xu L, Kiptanui Z, Perlman E, Bundschuh O, Harris I, Brandt N, Cooke C. The Part D Enhanced Medication Therapy Management (MTM) Model: Monitoring Findings As the Model Enters Year Two. Academy Health Annual Research Meeting (ARM), Washington, DC, June 2019.

Brandt N, Chou J, Cooke CE, Sharma K. A National Survey of Medicare Beneficiary Perspectives on the Medicare Part D Medication Therapy Management (MTM) Standardized Format. 2019 PQA Annual Meeting, May 2019. Platform presentation at PQA Rapid Fire Research Rounds session, and poster presentation.

Cooke CE, Sharma K, Chou J, Brandt N, Pellegrin K. National Survey Findings of Medicare Beneficiary Perspectives of the Medicare Part D Medication Therapy Management Standardized Format, American Geriatrics Society 2019 Annual Scientific Meeting, Portland, OR, May 2019.

Brandt NJ, Cooke CE, Sharma K, Chou J, Carden MJ, Kumbera P, Pellegrin K. Listening to the Medicare beneficiaries: Findings from a National Survey on the Medication Therapy Management (MTM) Standardized Format. AMCP Annual Meeting 2019, San Diego, CA, March 2019. https://www.jmcp.org/doi/pdf/10.18553/jmcp.2019.25.3-a.s1

Sharma K, Cooke CE, Howard AK, Chater R, Brandt NJ. Listening to the Medicare Beneficiaries’ voice to optimize the MTM Program Standardized Format. National Institutes of Aging/Center for Research and Aging Symposium, March 4, 2019.

Chou J, Cooke CE, Sharma K, Brandt NJ. A National Survey of Medicare Beneficiary Perspectives on the Medicare Part D Medication Therapy Management (MTM) Standardized Format. National Institutes of Aging/Center for Research and Aging Symposium, March 4, 2019.

Sharma K, Cooke CE, Howard AK, Chater R, Vogler A, Brandt N. Listening to the Beneficiaries’ Voice to Optimize the MTM Program Standardized Format. ASCP Annual Meeting, National Harbor, Maryland. November 2018.

Sharma K, Cooke CE, Howard AK, Chater R, Vogler A, Brandt N. Beneficiary-driven changes to the Part D Medication Therapy Management (MTM) Standardized Format. AMCP Nexus, Orlando, FL October 2018.

Evaluation of Medicare Part D MTM Program Standardized Format. Presented to Centers for Medicare & Medicaid Services (CMS), Medicare Drug Benefit and C and D Data Group, Division of Clinical and Operational Performance. October 2018.

Evaluation of Medicare Part D MTM Program Standardized Format. Presented to AMCP MTM Advisory Group, AMCP Annual Meeting, Boston, MA, April 2018.

Pain Management and Policy

Due to their age and medical complexity, older adults are more likely to suffer one or more conditions, such as arthritis, cancer, and bone fractures, that have pain as a major symptom. Exposure to potent opioid analgesics can result in adverse effects, including respiratory depression, sedation, and overdose. State and national mandates to reduce opioids due to their addiction potential may limit older adults’ access to necessary pain medications. The impact of such policies on pain management and the development of substance use problems is relatively understudied in older adults and is an important focus of our research.

Publications

Resnick, B., Boltz, M., Galik, E., Holmes, S.D., Vigne, E., Fix, S., Zhu, S., Renn, C., Dorsey, S. (2019). Pain assessment, management, and impact among older adults in assisted living. Pain Management Nursing, 20(3), 192-197.

Lumish R, Goga JK, Brandt NJ. (2018) Optimizing Pain Management Through Opioid Deprescribing. J Gerontol Nurs. 2018 Jan 1;44(1):9-14. doi: 10.3928/00989134-20171213-04.

Roberto, P., Brandt, N., Onukwugha, E., & Stuart, B. (2017). Redaction of Substance Abuse Claims in Medicare Research Files Affects Spending Outcomes for Nearly One in Five Beneficiaries with Serious Mental Illness. Health Services Research, 52(3), 1239-1248. doi:10.1111/1475-6773.12528.

Presentations

Fleming S, Kuzucan A, Simoni-Wastila L. Cocaine and Opioid Polysubstance-Related Hospital Events on the Rise in Maryland, 2016-2018.Podium Presentation at the Addiction Health Services Research Conference, Park City, UT, October 2019.

Kuzucan A, Fleming S, Simoni-Wastila L. Odds Of Discharge To Substance Abuse Treatment Or Psychiatric Care After Hospitalization for Alcohol or Drug Poisonings, Maryland 2016-2017. Poster presentation at the Addiction Health Services Research Conference, Park City, UT, October 2019.

Fleming S, Kuzucan A, Simoni-Wastila L. Predictors of in-hospital Psychiatric Care among Alcohol- and Drug- related Hospitalizations in Maryland, 2016. Poster presentation at 35th ISPE International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Philadelphia, PA, August, 2019.

Kuzucan A, Simoni-Wastila L. Unintentional and suicidal opioid overdose in Medicare beneficiaries. Poster presentation at ISPOR, New Orleans, La, May 2019.

Kuzucan A, Qato DM, Simoni-Wastila L. Characteristics Associated with Intentional Opioid Overdose in Medicare Beneficiaries. Poster presentation at the Addiction Health Services Research Conference, Savanah, Ga, October, 2018.

Kuzucan A, Simoni-Wastila L. Substance Use Disorders and Overdose Events in Medicare Beneficiaries. Poster presentation at 33rd ISPE International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Montreal, Canada, August 2018.

Tham T Le, Aida Kuzucan, Wang Yan, and Linda Simoni-Wastila. Validating the Latent Construct of Problematic Opioid Use Among Medicare Beneficiaries, ICPE Annual Meeting, August 2018, Prague, Czech Republic.

ABSTRACTS (UNDER REVIEW)
Kuzucan A, Simoni-Wastila L. Factors Associated With Opioid Use Among Long-Stay Nursing Home Residents. ICPE Annual Meeting 2020, Berlin, Germany.

Fleming, S, Olopoenia, A, Simoni-Wastila, L. Naloxone Dispensing and Opioid-Related Adverse Events in Maryland Medicaid Recipients, 2015-2018. ICPE Annual Meeting 2020, Berlin, Germany.

Olopoenia A, Fleming S, Simoni-Wastila L. Trends in gabapentin utilization in the United States, 2004-2016. ICPE Annual Meeting 2020. Berlin, Germany.

Deprescribing

Deprescribing is a systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences. Through clinical practice, research, policy initiatives as well as collaboration, the Lamy Center is helping to advance the science of deprescribing to optimize medication use and safety in older adults. Dr. Brandt represents the Lamy Center on the U.S. Deprescribing Research Network (USDeN) as a co-investigator for the Stakeholder Engagement Core. The goal of the USDeN is to develop and disseminate evidence about deprescribing for older adults, and in doing so to help improve medication use among older adults and the outcomes that are important to them. Funded by the U.S. National Institute on Aging, the network is a community of people united by a shared interest in improving research on deprescribing for older adults.

Publications

Brandt, N. Steinman, M.A. (2020), Optimizing Medication Management During the COVID ‐19 Pandemic: An Implementation Guide for Post‐Acute and Long‐Term Care. J Am Geriatr Soc. Accepted Author Manuscript. doi:10.1111/jgs.16573.

Ikeji C, Williams A, Hennawi G, Brandt NJ. Patient and Provider Perspectives on Deprescribing Proton Pump Inhibitors. J Gerontol Nurs. 2019 Oct 1;45(10):9-17.

Chou J, Tong M, Brandt NJ. Combating Polypharmacy Through Deprescribing Potentially Inappropriate Medications. J Gerontol Nurs. 2019 Jan 1;45(1):9-15.

Lumish R, Goga JK, Brandt NJ. Optimizing Pain Management Through Opioid Deprescribing. J Gerontol Nurs. 2018 Jan 1;44(1):9-14.

Presentations

Brandt, N. Steinman, M.A. May 29, 2020. AMDA-on-the-Go: https://paltc.podbean.com/e/medication-management-during-covid-19/

Sarkisian C, Reyes C, Brandt N. U.S Deprescribing Research Network Stakeholder Engagement Core Introductory Webinar; December 11th, 2019. Funded by NIA R24 AG064025-1.

Williams A, Brandt N, Umeozulu C, Hennawi G. Patient and Prescriber Perspectives on Proton Pump Inhibitor (PPI) Use and Deprescribing in Older Adults. American Society of Consultant Pharmacists. November 2018. National Harbor, MD.

Tong M. (2018, October). Deprescribing in Older Adults: A Stepwise Approach to Reduce Polypharmacy. University of Maryland School of Pharmacy Pharmacotherapy Rounds, Baltimore, MD.

Hennawi G. Courtin O, Crowley E, Lumish R, Brandt N. Reducing Healthcare Utilization in High Risk Older Adults: The Impact of an Interprofessional Care Team. American Geriatrics Society Annual Meeting May 2018. Orlando, FL.

Williams A, Brandt N, Umeozulu C, Hennawi G. Patient and Prescriber Perspectives on Proton Pump Inhibitor (PPI) Use in Older Adults: Is a Quality Measure Needed? Pharmacy Quality Alliance Annual Meeting. May 2018. Baltimore, MD.