Q&A: UH Hilo’s Karen Pellegrin discusses efforts to correct medication use health disparities among Hawaii’s indigenous populations

Faculty at the University of Hawaii at Hilo’s (UH Hilo) Daniel K. Inouye College of Pharmacy (DKICP) were recently awarded a $333,000 grant to develop a statewide infrastructure that identifies and works to correct existing medication use health disparities among Hawaii’s indigenous populations.

The grant was administered through the CMS’ Minority Research Grant Program. Karen Pellegrin, DKICP Director of Continuing Education and Strategic Planning and the grant’s principal investigator, discusses initiatives the grant will fund in this Q&A.

 

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State of Reform: The grant will be used to develop infrastructure to identify and correct medication use disparities among Hawaii’s indigenous populations. Can you give some examples of what types of disparities might exist among those populations?

Karen Pellegrin: “One of the priorities in the CMS Health Equity Framework for addressing systemic barriers to equity is expanding the collection, reporting, and analysis of standardized data. Our project will align with this priority by expanding the current Hawaii Health Information Exchange (HHIE) dashboard to collect, report, and analyze standardized data on medication-related acute care use by race, geography, and social vulnerability.  

This dashboard is currently being piloted through a health literacy grant award to Hawaii County for which UH Hilo serves as the evaluation partner. The ability to study race disparities among CMS beneficiaries using federal data is substantially limited by inaccuracies in race assignment except for [white and Black individuals]. This means federal race data might not be accurate for the majority of residents in Hawaii and for a growing number of Americans nationwide.  

The aggregation of subgroups of races in some cases actually hides some of the most severe disparities. For example, recent reports of life expectancies in the US almost completely masked Pacific Islander disparities due to inappropriate aggregation, demonstrating the importance of ensuring that methods are carefully designed to help rather than harm in research aiming to identify and address disparities. We hope to better understand medication-related disparities through this new CMS grant.”

SOR: What are some ways these funds can be utilized to help address these disparities?

KP: “In previous work funded by the CMS Innovation Center, our Pharm2Pharm model demonstrated that pharmacists are essential to higher quality and lower cost care. In this new CMS grant, we aim to test an adaptation of this Pharm2Pharm model designed to improve performance on CMS quality measures and close equity gaps.  

Co-investigator Wes Sumida has been previously funded to develop a culturally-tailored pharmacist screening tool to help identify and reduce barriers to medication adherence among Indigenous Pacific Peoples. We aim to test the use of this tool in a network of pharmacies.”

SOR: How does a tool like that work?

KP: “We are interested in working to develop a brief screening tool that pharmacists can use during their interactions with patients to help identify potential social needs barriers to medication adherence. This screening tool is envisioned to include a limited number of potential screening questions.”

SOR: Have local pharmacists expressed a need for this type of tool?

KP: “In the Pharm2Pharm model, our local pharmacists facilitated medication adherence by assessing health literacy, language, cultural, and social needs of their patients. However, feedback from these pharmacists indicated they needed help in these areas and that they felt they didn’t have sufficient time to adequately address these needs.  

We believe the screening tool Dr. Sumida is developing will help community pharmacists efficiently and effectively screen for social needs barriers to medication adherence in the most vulnerable populations.”

This Q&A was edited for clarity and length.

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