Accelerating Health Services Research
Joan Neuner, MD, MPH, is the associate chief for research for the Division of General Internal Medicine and has expertise in in primary care-focused health services and health delivery research.
Her research focuses in particular on improving long-term medication prescribing and adherence, particularly for women during and after menopause.
Better Adherence to Medications for Chronic Conditions
Poor medication adherence leads to many hospitalizations and deaths and can have many causes. For example, our lab showed that patients with osteoporosis and their providers can have very different thresholds for fracture risk and differing perceptions of when osteoporosis medication treatments are worthwhile.
Other studies from our lab suggested the importance of policy, showing that a Medicare subsidy to eliminate drug co-pays significantly improved medication adherence among low-income breast cancer patients—even surpassing the rates of higher-income groups.
Improving Care for Women in Midlife and Later
Incontinence and other conditions of mid to later life have large impacts on function and quality of life. They also carry high out of pocket and societal costs.
In a series of highly collaborative studies, we examined barriers to diagnosis and management. We tackled these barriers in primary care in a statewide randomized controlled dissemination and implementation study that touched over 100,000 patients, and have begun work using electronic health records and large language models to further streamline improvements and connections to specialty and community-based care.
Collaborators
- Kim Dittus, MD (Department of Medicine, Division of Hematology, Medical Oncology, and Palliative Care)
- Jennifer Weiss, MD, MS (Department of Medicine, Division of Gastroenterology and Hepatology)
- Maureen Smith, MD, MPH, PhD (Department of Population Health Sciences)
Active Projects
- Symptom Monitoring Using Patient-Reported Outcomes to Optimize Medication Use
The SyMPTOM randomized controlled trial will test whether clinical pharmacists (as touchpoints for oncology teams) can improve patient adherence to daily adjuvant endocrine therapy.
In this multicenter trial led by Dr Neuner and mPI Dr. Kathryn Flynn (Medical College of Wisconsin), routinely collected patient-reported symptom data will be paired with guideline-based pharmacist support to manage those symptoms.
- Chemotherapy Dosing in Patients with Obesity: Are Oncologists Optimally Balancing Risks and Benefits?
With recent advances in breast cancer treatment, options have increased at the same time as interest in deescalating care when possible so as to reduce side effects.
In this study we examine real-world breast cancer chemotherapy dosing, its variation by weight, comorbidity, age and other factors including supportive care use. We use electronic health record data from 13 large cancer centers, and will use advanced regression modeling to explore differences in dosing and mortality between groups.
- Improving Nonsurgical Care for Incontinence
We tackled barriers to early diagnosis and management of urinary incontinence in primary care in a statewide randomized controlled dissemination and implementation study.
Working with human factors engineers, we enrolled 36 primary practices across Wisconsin to examine the outcomes of an innovative menu-based practice facilitation intervention with and without partnership supports to community resources.
Funding Support
Dr. Neuner’s research is or has been funded by the National Cancer Institute, Department of Defense, Agency for Healthcare Research and Quality, National Institute on Diabetes Digestive and Kidney Disease, and the American Cancer Society.
