Next Steps...

Hey guys,

It feels like it’s been forever since I last updated. Life’s been busy with my friend’s wedding this past weekend and the week prior was my group’s Final presentation at the North Campus Research Complex (NCRC). I’m happy to say that the presentation went well! The grueling 3 hour meetings late into the evening to plan and prep helped immensely as our group walked out relatively unscathed from the barrage of questions from our Alzheimer's-Depression presentation for the senior clinical researchers, coordinators, and PI’s present in the audience.

Here is a picture of my awesome team.


Dr. Charles Burant, aka Chuck, if you’re reading this, thank you, thank you again for your dedication to mentoring our group. You definitely lead us, pushed us, and your experience with writing research grants helped us immensely as we were able to correctly predict what type of questions the audience were going to ask before the actual presentation. We were well prepared. Also, your enthusiasm is a rarity and I hardly see anyone who loves their job more.

Yesterday was my last day at the Taubman General Medicine clinic. I’ve reached the quota of patients and now shift my research responsibility focus into data entry and writing. I have over 200 surveys that I need to input into an Excel spreadsheet, then play around with the SPSS statistical software, and finally see what data I’ve obtained. Then I’ll write an abstract (due in a week, another deadline!), my report (what findings did I make/observe?) and finally make a poster of my results! I’m also hoping to write a paper and get it published, and have my own imprint in the science literature world (there’s something cool about contributing to knowledge). I’m excited because this will be my first poster, abstract, and report and I have BIG VISIONS for all.

I actually ran into a Psychiatry resident friend at my church a few Sundays ago, and told him the type of research I’ve been working on all summer. He was interested in what I’ve seen so far and my future results. He explained that at the psych clinic where he works, the doctors have been telling their patients about the inexpensive generic medication programs but they don’t know if their patients have actually utilized them. This is where my research can help. I will have REAL DATA to show how many patients (in general) have actually utilized an inexpensive generic medication program when the physicians or pharmacists tell their patients about such a program during their clinic visit. (As I blogged earlier, the Taubman General Medicine clinic doctors have informed their patients as well.) This research study could potentially open up more research opportunities, in that if we find that monetary reasons are not the reason why patients are not compliant in taking their medicine, then there must be some other variable that we are not aware of and need to investigate further. In fact, this outcomes report, I HOPE to distribute to ALL the physicians and pharmacists at the Taubman outpatient clinics at the University of Michigan Hospitals as well as the geriatric clinics who might benefit from reading the study.

The study may affect the way physicians/pharmacists practice to help their patients become more compliant in taking their medications, with the overall goal of seeing their heaths improve. I talked to Dr. Erickson about it recently, and what we’re doing this summer could potentially be an intermediate outcome (medication compliance), with the long term outcome being the overall health improvement of patients utilizing a generic inexpensive program. To monitor improvements in the patient's health we can obtain information from their charts and monitor their numbers (cholesterol, hA1c levels, blood pressure, etc). I would then try to get it published and possibly show how a physician/pharmacists intervention actually led to better health outcomes and that it can be implemented at hospital nationwide. Not bad from an idea that came from a summer research project.

Last thoughts on my time at the Taubman General Medicine Clinic: I’m grateful for the experience. It’s been a while since I’ve talked to real patients, and heard their burdens with their diseases, medications, and the U. S. health care system. Too often during the school year I’m just trying to survive my classes that I forget the reason why I went into health care – and that is to improve the lives of patients in a definite way. I’m also grateful for this summer experience because I got a chance to learn more about the state of Michigan (I’m from California). I constantly met retirees from the auto industry at the clinic and saw how important the auto industry is for Michigan residents and this made the recent downhill in the car industry more impactful to my life.

Finally, I ran into a Michigan Senator at clinic! Unbeknownst to me at the time, I asked Michigan Senator Robert Patterson to participate in my research. And after I found out he was a Senator, we got to talk about an assortment of topics before he was called in. We talked about the recent Michigan election, his thoughts on the recent (and future) health care reform, living a public life, and how hostile politics have become recently. Unfortunately he was called in before I could talk about ways that Pharmacists can be used to improve the health care delivery and system. But I did get a chance to take a photo with him and got his business card. This is one bridge I certainly want to continue building!

A Taste of Grey's Anatomy in Ann Arbor

Have you ever watched those medical shows with those handsome doctors who talk oh so lovely to their patients to enroll them into a clinical trial they are conducting? Well that's what my life has been like this summer except for the lack of a McDreamy hair cut and the fooling around with medical interns in the on-call room.

These past 8 weeks, I've been at the Taubman General Medicine Clinic at the University of Michigan Health System Hospital doing a study with the Pharmacists and Physicians on where their patients go to obtain their prescription medications. Co-blogger Alex Tungol actually did a similar study 2 years ago with Dr. Erickson through the summer MCRiT program as well. This gives me the ability to compare my results with hers, after I analyze my data with statistics. It will be interesting to see if any trends have developed in the two years. It's been a while since I've taken Statistics (and I never knew how significant it is to research) so this provides an opportunity to freshen up in my Excel and SPSS programing. Once I get my results, Dr. Erickson and I will analyze it, make a research poster, write a paper on it, and hopefully get published in a scientific journal!

For this project, specifically we're looking at whether the Recession and the two year advertisement campaign of the $4 inexpensive generic programs offered by major chain pharmacies ( such as Kroger, Walmart, and Target) have had any effect on the behavior of general medicine patients of where they go to get their prescriptions filled. We'll also be able to see if these incentive program have lead to increased medication adherence and other prescription behaviors. Furthermore, this outcome research affects the Physicians and Pharmacists directly at the Taubman Medical Clinic because many have been pushing their patients to utilize these types of prescription programs.

My primary job these past 8 weeks have been to enroll patients into the study. I've been humbled to say the least. From this experience, I now understand how difficult it is to enroll patients into any study - whether it be a simple 15 minute psychology study or a complicated clinical trial involving a new experimental drug for cancer patients undergoing chemotherapy. What I found to be alarming is that there are thousands of studies that are going on at UofM right now, but each year many studies lose their funding because they do not enroll sufficient patients the grant requires for their federal funding. This explains why I'm always bombarded with fliers (and now e-mails) asking me to participate in a study with cash incentives or ipod giveaways. It's serious business. And quite stressful if you're the clinical coordinator in charge of getting enough patients for the study. Your funding depends on it!

My study required me to enroll ~200 patients. To say it bluntly, I've never been rejected so many times in my life. Some days were good, others were not so good. Great days were when I enrolled 17 patients into the study and walked out of the clinic triumphantly! But there were many days when I only got 4 or 5 patients in a span of six hours at clinic and left feeling dejected. I guess in research, some days things will go your way, but other days they won't. The important thing is to persevere, not quit, and plan for the unexpected. A quote by Louis Pasteur provides insight : "luck favors the prepared."

One thing this research project has allowed me to do is to talk to patients again - something I haven't done so much since my days working at a community pharmacy. I'll be the first to admit, I do not have McDreamy hair or a McSteamy body, but I love to talk with people. My chief duties was to provide informed consent - specifically that the study was completely voluntarily and that there would be no benefit for participating. Since there was no compensation, I had to win them over with my McTastic smile! :)

I learned as much from the patients as they learned from me. I met at clinic a professional baker who explained to me the science of baking by enlightening me with how it's as much science as art - do not add too much salt when baking bread or the yeast will die and your dough won't rise! I met at clinic a couple who crossed the Canadian border monthly to get some of their prescriptions because of the drastic savings. And I even ran into the Dean of Admissions of the College of Pharmacy, Dean Perry, at clinic! She graciously volunteered to participate in my study (see the re-enactment picture at the end of the post)!

To pass the time on those extra slow days, I created activities to keep myself busy. I read.....a lot, and I kept a journal each day at clinic to record my observations and my thoughts. This practice is a good habit to develop now in my young professional career - to write down every observation I see in research. They are great resources to go back to when I write my final report but also helped pass the time on those extra slow days of research. I've found research to be a slow, methodical, surgical process....but without this process there would be no good science that results from it. I'll be keeping Louis Pasteur's famous words in mind: Luck favors the prepared.

If anyone has questions about MCRiT send an e-mail to me at : cqtruong@umich.edu