Leah Zullig

Overview:

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is an Associate Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address the reduction of healthcare disparities, improving cancer care delivery and quality, supporting medication adherence, and promoting cancer survivorship and chronic disease self-management. She has authored over 100 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research

Positions:

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Associate Professor in Medicine

Medicine, General Internal Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2013

University of North Carolina - Chapel Hill

Fellow

Washington University in St. Louis

Grants:

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

A Clinic-Based Behavioral Intervention to Reduce Cardiovascular Disease Risk in Persons Living with HIV

Administered By
Medicine, Infectious Diseases
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

PhRMA Editorial

Administered By
Population Health Sciences
Awarded By
PhRMA Foundation
Role
Investigator
Start Date
End Date

PRoteus OnCology fEaSibility Study (PROCESS)

Administered By
Population Health Sciences
Awarded By
Proteus Digital Health, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

BACKGROUND: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. METHODS: Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. RESULTS: Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. CONCLUSION: Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.
Authors
Drake, C; Batchelder, H; Lian, T; Cannady, M; Weinberger, M; Eisenson, H; Esmaili, E; Lewinski, A; Zullig, LL; Haley, A; Edelman, D; Shea, CM
MLA Citation
Drake, Connor, et al. “Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.Bmc Health Serv Res, vol. 21, no. 1, Sept. 2021, p. 975. Pubmed, doi:10.1186/s12913-021-06991-3.
URI
https://scholars.duke.edu/individual/pub1496976
PMID
34530826
Source
pubmed
Published In
Bmc Health Services Research
Volume
21
Published Date
Start Page
975
DOI
10.1186/s12913-021-06991-3

LACK OF INFORMATION IN RANDOMIZED CONTROLLED TRIALS TO GUIDE TRANSLATION OF MEDICATION ADHERENCE INTERVENTIONS TO CLINICAL PRACTICE: SYSTEMATIC REVIEW

Authors
Ribaut, J; Kostalova, B; Dobbels, F; Gerull, S; Mala-Ladova, K; Zullig, LL; De Geest, S
MLA Citation
URI
https://scholars.duke.edu/individual/pub1496069
Source
wos-lite
Published In
Transplant International : Official Journal of the European Society for Organ Transplantation
Volume
34
Published Date
Start Page
345
End Page
345

Do Medicare part D low-income subsidies narrow disparities in orally-administered antimyeloma therapy initiation?

Authors
Jazowski, SA; Samuel-Ryals, CA; Wood, WA; Zullig, LL; Trogdon, JG; Dusetzina, SB
MLA Citation
Jazowski, Shelley A., et al. “Do Medicare part D low-income subsidies narrow disparities in orally-administered antimyeloma therapy initiation?Pharmacoepidemiology and Drug Safety, vol. 30, 2021, pp. 39–40.
URI
https://scholars.duke.edu/individual/pub1496070
Source
wos-lite
Published In
Pharmacoepidemiology and Drug Safety
Volume
30
Published Date
Start Page
39
End Page
40

Impact of financial medication assistance on medication adherence: a systematic review.

BACKGROUND: The prevalence of financial medication assistance (FMA), including patient assistance programs, coupons/copayment cards, vouchers, discount cards, and programs/pharmacy services that help patients apply for such programs, has increased. The impact of FMA on medication adherence and persistence has not been synthesized. OBJECTIVE: The primary objective of this study was to review published studies evaluating the impact of FMA on the three phases of medication adherence (initiation [or primary adherence], implementation [or secondary adherence], and discontinuation) and persistence. Among these studies, the secondary objective was to report the impact of FMA on patient out-of-pocket costs and clinical outcomes. METHODS: A systematic review was performed using MEDLINE and Web of Science. RESULTS: Of 656 articles identified, eight studies met all inclusion criteria. Seven studies examined FMA for medications treating cardiovascular diseases, while one study assessed FMA for cancer medications. Among included studies, FMA had a positive impact on medication adherence or persistence, and most measured this impact over one year or less. Of the three phases of medication adherence, implementation (5 of 8) was most commonly reported, followed by discontinuation (3 of 8), and then initiation (1 of 8). Regarding implementation, users of FMA had a higher mean medication possession ratio (MPR) than nonusers, ranging from 7 to 18 percentage points higher. The percentage of patients who discontinued medication was 7 percentage points lower in users of FMA versus nonusers for cardiovascular disease states. In one cancer study, FMA had a larger impact on initiation than discontinuation, ie, compared to nonusers, users of FMA were less likely to abandon an initial prescription (risk ratio= 0.12, 95% confidence interval [CI]: 0.08-0.18), and this effect was larger than the decreased likelihood of discontinuing the medication (hazard ratio = 0.76, 95% CI: 0.66-0.88). In 3 of 8 studies reporting on medication persistence, FMA increased the odds of medication persistence for one year ranged from 11% to 47%, depending on the study. In addition to adherence, half of the studies reported on FMA impacts on patient out-of-pocket costs and 3 of 8 studies reported on clinical outcomes. Impacts on patient out-of-pocket costs were mixed; two studies reported that out-of-pocket costs were higher for users of a coupon or a voucher versus nonusers, one study reported the opposite, and one study reported null effects. Impacts on clinical outcomes were either positive or null. CONCLUSIONS: We found that FMA has positive impacts on all phases of medication adherence as well as medication persistence over one year. Future studies should assess whether FMA has differential impacts based on phase of medication adherence and report on its longer-term (ie, beyond one year) impacts on medication adherence. DISCLOSURES: This work was sponsored by a grant from Pharmaceutical Research and Manufacturers of America (PhRMA). PhRMA had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Hung reports past employment by Blue Cross Blue Shield Association and CVS Health and a grant from PhRMA outside of the submitted work. Zullig reports research funding from Proteus Digital Health and the PhRMA Foundation. consulting fees from Novartis. Reed reports receiving research support from Abbott Vascular, AstraZeneca, Janssen Research & Development, Monteris, PhRMA Foundation, and TESARO and consulting fees from Sanofi/Regeneron, NovoNordisk, SVC Systems, and Minomic International, Inc. Bosworth reports research grants from the PhRMA Foundation, Proteus Digital Health, Otsuka, Novo Nordisk, Sanofi, Improved Patient Outcomes, Boehinger Ingelheim, NIH, and VA, as well as consulting fees from Sanofi, Novartis, Otsuka, Abbott, Xcenda, Preventric Diagnostics, and the Medicines Company. The other authors have nothing to report. This work was presented as a poster presentation at the ESPACOMP Annual Meeting in November 2020.
Authors
Hung, A; Blalock, DV; Miller, J; McDermott, J; Wessler, H; Oakes, MM; Reed, SD; Bosworth, HB; Zullig, LL
MLA Citation
Hung, Anna, et al. “Impact of financial medication assistance on medication adherence: a systematic review.J Manag Care Spec Pharm, vol. 27, no. 7, July 2021, pp. 924–35. Pubmed, doi:10.18553/jmcp.2021.27.7.924.
URI
https://scholars.duke.edu/individual/pub1487498
PMID
34185554
Source
pubmed
Published In
J Manag Care Spec Pharm
Volume
27
Published Date
Start Page
924
End Page
935
DOI
10.18553/jmcp.2021.27.7.924

The INSPIRE Population Survey: development, dissemination and respondent characteristics.

BACKGROUND: Most older adults prefer to continue living at home despite increasing care needs and demand for services. To aid in maintaining independence, integrated care models for community-dwelling older people are promoted as the most cost-effective approach. The implementation of such care models is challenging and often the end-users are not involved or their needs are not considered. We conducted a population survey in order to understand the needs and preferences of home-dwelling older adults living in Canton Basel-Landschaft, Switzerland. The aims of this paper are to chronicle the development of the INSPIRE Population Survey, outline its variables and measurements, describe the marketing strategy utilized for survey dissemination and report on the response rate and respondent characteristics. METHODS: The INSPIRE Population Survey, conducted between March and August 2019, is a cross-sectional survey of older adults aged 75 and older living at home in Canton Basel-Landschaft. The questionnaire was developed by expert input and stakeholder involvement. Its readability and acceptability were pilot-tested with older people. To ensure the likelihood of a high and representative response rate, a meticulous step-by-step marketing strategy was developed prior to the dissemination of the questionnaire. RESULTS: The overall response rate was 30.7% (n = 8,846), with variations between 20.6 and 34.5% across the different care regions in the canton. A generally higher response rate was found in the care regions with a higher density and which bordered the urban city of Basel. We received support from local stakeholders, policy makers and media through using a broad combination of marketing channels and targeting our community partners who have a strong relationship with our target audience. CONCLUSIONS: Although recruiting older adults in research is challenging, our study shows that a high response rate can be achieved by developing the survey through expert input and by involving all important stakeholders, including older adults, throughout the entire process.
Authors
Siqeca, F; Obas, K; Yip, O; Stenz, S; Vounatsou, P; Briel, M; Schwenkglenks, M; Quinto, C; Blozik, E; Zeller, A; Zullig, LL; De Geest, S; Deschodt, M
MLA Citation
Siqeca, Flaka, et al. “The INSPIRE Population Survey: development, dissemination and respondent characteristics.Bmc Med Res Methodol, vol. 21, no. 1, June 2021, p. 131. Pubmed, doi:10.1186/s12874-021-01329-3.
URI
https://scholars.duke.edu/individual/pub1485643
PMID
34162324
Source
pubmed
Published In
Bmc Medical Research Methodology
Volume
21
Published Date
Start Page
131
DOI
10.1186/s12874-021-01329-3

Research Areas:

Attitude to Health
Behavior Therapy
Benchmarking
Cancer
Cardiovascular Diseases
Caregivers
Clergy
Communication
Delivery of Health Care
Delivery of Health Care, Integrated
Diabetes Complications
Diabetes Mellitus
Diabetes Mellitus, Type 2
Diffusion of Innovation
Disclosure
Disease Management
Drug Packaging
Evidence-Based Medicine
Feasibility Studies
Glycated Hemoglobin A
Guideline Adherence
Health Care Costs
Health Expenditures
Health Services Accessibility
Healthcare Disparities
Hemoglobin A, Glycosylated
Hypertension
Minority Health
Oncology
Osteoarthritis
Outcome and Process Assessment (Health Care)
Pastoral Care
Patient-Centered Care
Pilot Projects
Program Evaluation
Quality of Health Care
Quality of Life
Religion and Psychology
Reproducibility of Results
Self Care
Survivors
Telemedicine
Treatment Outcome
Veterans Health