Faculty Spotlight: Mick Murray, PharmD, MPH
Mick Murray, PharmD, MPH |
Research Interests
Developing pharmacy services that improve drug use in patients with chronic disorders such as high blood pressure or asthma, determining how computers prevent errors in prescribing, use of health care by low-income minority groups, and pharmacoepidemiology.
The way Mick Murray sees it, if an electronics store provides customers with as much information as possible before they buy a cell phone, a pharmacy should do no less for patients buying medications.
“What we have is a bunch of people running around that know more about their cell phones and DVDs than they do about the potent medications that they take,” says Murray, who chairs the UNC Eshelman School of Pharmacy’s Division of Pharmaceutical Outcomes and Policy. “There’s something wrong with that picture.”
Murray is working to make that picture right by studying how new pharmacy services help patients take their medications properly. One such service, Murray says, is simply asking more questions when patients pick up their prescriptions at pharmacies.
“One thing we’d like to do is verbally instruct people more at that point, and to make sure they know what they’re doing with their medications when they leave, because there’s just not enough instruction,” he says.
“Some people go home with a leaflet in their bag, but they can’t read. If you can’t read even the label, you’re not going to take the medication the right way. Those are the kind of services that could improve the chance of the drug working better.”
Tracking Drug Therapy
One of Murray’s research interests focuses on older patients with cardiovascular conditions. One of the tools he uses is a medication container that has a computer chip implanted in the lid. Each time the container is opened, the chip records a time stamp. Researchers can extract the information from the chip to see how much and how regularly patients are taking their medication. That data helps determine how much new pharmacy services are helping patients take their medication more reliably.
Murray also studies the use of health-care by low-income minorities, an interest that grew out of the fact that he has conducted most of his studies in inner cities.
“A lot of the work that I’ve done have been in the city-county hospitals, and most of those people don’t have many resources, including money, so that’s been a target of interest,” Murray says. “We’ve done a number of different studies looking at the cost of heart failure, cost of asthma, more or less burden-of-illness studies.”
Murray is studying two main pharmacy services: providing clearer instructions that accompany the medications and having pharmacists spend more time with patients to answer their questions.
“In heart failures, we know it reduces emergency-department visits and hospitalizations, and these are problems that cost patients and health care more money,” Murray says. “When you provide more information to patients and help them try to take their medications more reliably, costs go down because things like hospitalizations and emergency-room visits go down.”
Managing Heart Disease and High Blood Pressure
Murray has also been looking at the pharmacist’s role in helping patients manage cardiovascular disease and high blood pressure. A study he published in the April 27, 2009, issue of the Archives of Internal Medicine found that people with high blood pressure and heart disease, including heart failure, were more than a third less likely to experience problems with their medications when under a pharmacist’s care than patients who received no special attention from a pharmacist. Preventing unnecessary hospitalizations, emergency room visits and associated health-care costs saved approximately $2,600 per patient.
“By working closely with doctors and nurses, pharmacists can help people avoid problems with their medications for chronic conditions such as high blood pressure and heart failure with favorable effects on health and health-care costs,” Murray says.
In the study, researchers monitored two types of patients for approximately one year. Complicated patients had been previously diagnosed with heart failure, coronary heart disease, stroke, heart attack, or kidney problems. Uncomplicated patients had high blood pressure but no other evidence of a heart or kidney condition. All were taking at least one medication, with complicated patients taking an average of more than ten. The 800 patients had an average age of fifty-nine and received their care from Wishard Health Services, a city-county hospital in Indianapolis.
Complicated and uncomplicated patients assigned to the control group did not receive any extra attention from a pharmacist. Patients in the intervention group were assigned to a pharmacist who took a medical history, tracked medication refills, monitored body weights and laboratory tests, taught patients how to best take their medications, and communicated regularly with patients and their doctors and nurses.
Over the study period, 90 percent of all adverse events that occurred were experienced by participants in the complicated group who had more serious heart conditions. However, researchers found that a pharmacist’s guidance and advice reduced adverse drug events and medication errors by 34 percent.