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Demetra Antimisiaris, PharmD, BCGP, FASCP

 Health Management and Systems Sciences
Associate Professor, Director, University of Louisville Polypharmacy Innovation Center
Frazier Polypharmacy and Medication Management Program
485 E. Gray St., Louisville, KY 40202
Phone: 502-852-2813
Office: SPHIS 111
Office Hours: By appointment
deanti01@louisville.edu

CURRICULUM VITAE

Bio

Demetra Antimisiaris is an Associate Professor, who joined the University of Louisville School of Public Health and Information Science in August of 2019.  Dr. Antimisiaris started at U of L in 2007 from the private sector, to lead the Polypharmacy Initiative which became the UofL Frazier Polypharmacy and Medication Management Program in 2016. The Frazier Polypharmacy Program is dedicated to education, research and public awareness regarding polypharmacy. 

Dr. Antimisiaris was educated at the University of California at Davis, and the University of the Pacific where she graduated with a degree in clinical pharmacy (Doctor of Pharmacy or PharmD). Then, she completed a clinical pharmacy residency in Geriatric Pharmacotherapy at the VA Sepulveda (Los Angeles), a UCLA affiliated, interdisciplinary Geriatric Training Program (1989). She worked as a Consultant Pharmacist after graduating from residency where she reviewed nursing home (long term care) charts for medication use optimization as mandated by federal law. Dr. Antimisiaris attributes her ability to assess medication use appropriateness to lessons learned from the dedicated staff who care for older persons in long term care as well as the VA-UCLA training program, which was a trailblazing program supported by the VA and Reynolds Foundation. The Reynolds Foundation and VA programs produced many leaders in the field.

Dr. Antimisiaris believes “you can’t study what you don’t do”, so she makes a point to provide clinical consultation and participate in patient care while working to help grow the body of scholarship regarding polypharmacy. She has authored book chapters, served as guest editor of a Clinics in Primary Care Office Practice-Geriatrics edition, authored journal pieces, and develops education sessions (a mission of the Frazier Polypharmacy Program). In 2019, she was awarded the American Society of Consultant Pharmacists Archambault Award. The Archambault Award is the Society’s highest honor conferred to an individual for their outstanding contributions to the profession. Selected by past Archambault award winners. Past winners include Mark Beers, Joseph Hanlon, Jerry Gurwitz, and many others that Dr. Antimisiaris considers more deserving than she.  https://www.ascp.com/page/awards. She considers this award a recognition of the innovative University of Louisville’s Frazier Polypharmacy Program.

Dr. Antimisiaris also serves as Assistant Dean for Continuing Education and Professional Development and has a part time appointment in the U of L School of Medicine, Department of Neurology. Her research interests center on multi-stakeholder decision-making regarding medication use.

Select Publications:

Zanjani, F., Allen, H., Smith, R.V., Antimisiaris, D., Schoenberg, N., Martin, C., Clayton, R. (2018). "Pharmacy Staff Perspectives on Alcohol and Medication Interaction Prevention Among Older Rural Adults." Gerontol Geriatr Med 4: 2333721418812274.

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. The main categories identified for AMI prevention messaging were Informational, Health Significance, and Recommendations. Within barriers to participation, the main categories identified were Health Illiteracy, Personal Attitudes, and Feasibility. The main categories identified for program facilitators were Understanding, Beneficial Consequences, and Practicality. Multimethod dissemination strategies were commonly suggested. This study found positive pharmacy staff perspectives for the planning and implementation of AMI prevention programming, and future development and feasibility testing of such programming in the pharmacy setting is warranted.

Polivka, B. J. Folz, R., Myers, J. Barnett, R., Antimisiaris, D., Jorayeva, A., Beatty, B. (2018). "Identifying phenotypes and factors impacting outcomes in older adults with asthma: A research protocol and recruitment results." Res Nurs Health 41(4): 336-345.

Success in testing research outcomes requires identification of effective recruitment strategies in the targeted population. In this paper, we present the protocol for our NIH-funded study as well as success rates for the various recruitment strategies employed. This longitudinal observational study is: developing a phenotyping algorithm for asthma in older adults, exploring the effects of the asthma phenotype and of volatile organic compounds on asthma control, and developing a predictive model of asthma quality of life. A sub-aim is to characterize barriers to successful medication management in older adults with asthma. Individuals are eligible if they are >/=60 years, have a positive response to at least 1 of 6 asthma screening questions, are non-smokers, and demonstrate bronchodilator reversibility or a positive bronchial challenge test with methacholine. Exclusion criteria are smokers who quit <5 years ago or with a >20 pack year smoking history, and those having other chronic pulmonary diseases. Participants (N = 190) complete baseline pulmonary function testing, questionnaires, sputum induction, skin prick testing, and have blood drawn for Vitamin D and Immunoglobulin E. Home environmental assessments are completed including 24-hr particulate and volatile organic compound measurements. At 9-months post-baseline, home spirometry, medication assessment, and assessment of asthma quality of life and asthma control are assessed. At 18-months post-baseline, home spirometry, completion of baseline questionnaires, and a home environmental assessment are completed. We have employed multiple recruitment efforts including referrals from clinical offices, no-cost media events, flyers, and ads. The most successful efforts have been referrals from clinical offices and media events.

Furman, C. D., Wagner, L., Gomes, J., Gopalraj, R., Parker, B.F., Morton, L., Antimisiaris, D., Neamtu, D., Masroor, S., Martin-Galijatovic, R., Cotton, S., Shaw, M.A. (2018). "Implementing Chief Resident Immersion Training (CRIT) in the Care of Older Adults: Overcoming Barriers and Promoting Facilitators." Geriatrics (Basel) 3(4).

The Chief Resident Immersion Training (CRIT) in the Care of Older Adults curriculum was developed at Boston University School of Medicine to improve the care of older adults through an educational intervention. The curriculum targeted chief residents (CRs) because their role as mediators between learners and faculty provides the greatest potential impact for transmitting knowledge. The goals of CRIT are to: (1) provide education on geriatric principles and on teaching/leadership skills, (2) foster interdisciplinary collaboration, and (3) complete an action project. This study demonstrates successful implementation of CRIT at a different academic institution in a rural state. The CRs indicated that their confidence in their ability to apply and teach geriatrics improved after CRIT. In addition, the CRs indicated that CRIT improved their confidence in their overall skills as CRs. The barriers and facilitators to implementation are addressed in order to promote successful adoption of CRIT at other institutions, including those in rural states.

Cavallazzi, R., Jorayeva, A., Beatty, B.L., Antimisiaris, D., Gopalraj, R., Myers,J., Folz, R.J., Polivka, B.J. (2018). "Predicting asthma in older adults on the basis of clinical history." Respir Med 142: 36-40.

BACKGROUND: The diagnosis of asthma is not always straightforward and can be even more challenging in older adults. Asthma is ideally confirmed by demonstration of variable expiratory airflow limitation. However, many patients with asthma do not demonstrate airflow obstruction nor show bronchodilator reversibility. We aimed to investigate predictors for a positive bronchial challenge test with methacholine in older adults being evaluated for asthma. METHODS: This is a diagnostic accuracy study with a cross-sectional design. Participants >/=60 years with suspected asthma and a negative postbronchodilator response on spirometry were included. All participants underwent a methacholine challenge test (MCT). We assessed the value of standard asthma screening questions and additional clinical questions to predict the MCT results. A multivariable logistic regression model was developed to assess the variables independently impacting the odds of a positive MCT result. RESULTS: Our study included 71 participants. The majority were female (n=52, 73.2%) and the average age was 67.0 years. Those with a positive MCT (n=55, 77.5%) were more likely to have wheezing or coughing due to allergens (n=51, 92.7% vs. n=12, 75.0%; P=0.004) and difficulty walking several blocks (n=14, 25.5% vs. n=1, 6.3%, P=0.009). After adjustment, having wheezing or coughing due to allergens (OR=4.2, 95% CI 1.7-7.8, P=0.012) remained the only significant independent predictor of a positive MCT. CONCLUSIONS: In older adults with suspected asthma, questioning about wheezing or coughing due to allergens provides a modest independent value to predict a MCT result in those who previously had a negative postbronchodilator response on spirometry.

Bae, K. H., Jones, M., Evans, G., Antimisiaris, D.. (2019). "Simulation modelling of patient flow and capacity planning for regional long-term care needs: a case study." Health Syst (Basingstoke) 8(1): 1-16.

The need for Long-Term Care (LTC) arises in the elderly population, especially those reaching age 65 each year. This elderly population will grow tremendously in the United States over the next decade, resulting in short- and long-term challenges of matching resource capacity with uncertain demand for hospitals and other healthcare providers. This paper describes research involving the development of a simulation model of patient flow in order to understand the relationship between capacity and demand, and to investigate the impacts on performance measures such as average wait times for LTC patients. We propose an aggregate capacity model to consider patient flow among various types of care providers by integrating hospitals, nursing homes, assisted living facilities, and home health care. Using the data including patient demographics and service provider information, we forecast patient demand for LTC. The computational results demonstrate the efficacy of a simulation-based optimisation solution approach for capacity planning.

Antimisiaris, D., Bae, K., G., Morton, L., Gully, Z. . (2017). "Tamoxifen Pharmacovigilance: Implications for Safe Use in the Future." Consult Pharm 32(9): 535-546.

OBJECTIVE: To survey the status of current tamoxifen pharmacovigilance documentation reflecting tamoxifen use in an academic outpatient multispecialty practice in older adults. This data will help provide information to develop improved pharmacovigilance for a growing cohort of older adult users. The data will be utilized by an interdisciplinary team developing new methods of identifying factors for individualized pharmacovigilance in older adults. DESIGN: Retrospective chart review to gather descriptive and quantitative data on tamoxifen pharmacovigilance. SETTING: Multi-specialty clinic. PATIENTS: Ninety-three patients 60 years of age and older. MAIN OUTCOME MEASURES: Quantitative report of tamoxifen monitoring as well as descriptive analysis of individual cases. RESULTS: We found 19 cases of serious adverse events possibly related to tamoxifen (thrombi, uterine malignancies). There were 15 cases with no documentation of pharmacovigilance. All cases had incomplete pharmacovigilance documented. There were two cases of hypercalcemia. There was one case of tamoxifen discontinuation resulting from muscle pain and with chronic muscle pain complaints while receiving tamoxifen. We observed a correlation in older age or high comorbidity burden patients and adverse events patients. CONCLUSION: Some studies direct the important pharmacovigilance toward prevention of thrombi, uterine malignancies, and hypercalcemia; however, it is not easy to identify recommendations for frequency or focus of monitoring to prevent adverse events for individual older adults based on existing recommendations. The data collected and presented in this study serve to heighten awareness of tamoxifen pharmacovigilance and as a starting point for the application of machine learning techniques and modeling to identify high-risk patients and individualized pharmacovigilance recommendations.

Antimisiaris, D. and L. Morton (2017). "The Urgent Need for Robust Geriatric Patient Care Skills in Primary Care." Prim Care 44(3): xv-xvi.  [Editor’s Forward; Primary Care Clinics Office Practice-Geriatrics]

Antimisiaris, D. and T. Cutler (2017). "Managing Polypharmacy in the 15-Minute Office Visit." Prim Care 44(3): 413-428. [Chapter, Primary Care Clinics Office Practice-Geriatrics]

Polypharmacy is an underappreciated factor in undesirable patient outcomes. In older adults, polypharmacy is considered a syndrome of harm and presents a challenge to primary care providers. The United States has one of the highest medication use rates per capita in the world. With the aging population, and polypharmacy a significant part of the lives of older adults, management of polypharmacy poses both a growing challenge and an opportunity for all health care providers. This article provides an overview of skills to improve medication use management in older adults living with polypharmacy.

Zanjani, F., Crook, L., Smith, R., Antimisiaris, D., Schoenberg, N., Martin, C., Clayton, R. (2016). "Community pharmacy staff perceptions on preventing alcohol and medication interactions in older adults." J Am Pharm Assoc (2003) 56(5): 544-548.

OBJECTIVES: To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (>/=65 years of age). METHODS: A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students. RESULTS: Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives. CONCLUSION: Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention.

Casey, D. A., Antimisiaris, D., O’Brien, J. (2010). "Drugs for Alzheimer's disease: are they effective?" P T 35(4): 208-211.

Leey, J., Setters, B., Murph, P., Antimisiaris, D., Miles, T. (2009). "Quetiapine-induced dystonia and agitation in Parkinson's disease with dementia: a case report." J Am Geriatr Soc 57(5): 918-919.

Other select work:

  • Antimisiaris, D., Cheek, D.  Polypharmacy (Text Book Chapter) 2013 Gerontological Nursing 3rd Edition, Editor Kristen L. Mauk. Pp.416-454. Jones & Bartlett Learning Publisher. ISBN: 1-978-1-2840-2719.
  • Antimisiaris, D., Cheek, D.  Polypharmacy (Text Book Chapter) 2016 Gerontological Nursing 4rd Edition, Editor Kristen L. Mauk. Jones & Bartlett Learning Publisher.
  • American Geriatrics Society (AGS) Annual Meeting 2019.  “Practical and Efficient Approaches for Optimizing Medications and Deprescribing: An Inter professional Clinical Skills Workshop.” Granville, Tan, Wallhagen, Antimisiaris, Atkinson, Jeffery, Cacchione, Brennan, Resnick, Leigh, Gencarelli. May 2019, Portland, Oregon.
  • Gerontological Society of America Annual Meeting, Nov 15, 2018, Boston, MA. Specific Medication Literacy: What do People Know About the Medications They Take?  Antimisiaris D, Kreft K, Endicott D, Polivka B, Folz R.
  • International Association of Gerontology and Geriatrics (IAGG) 21st World Congress, San Francisco.  July 25, 2017. Are Protocols for Medication Holds Sufficient for Skin Prick Testing for Older Adults with Asthma?  Antimisiaris D, Polivka B, Folz R, Jorayeva A.   Abstract ID 2723513.
  • American Society of Health System Pharmacist Midyear Clinical Meeting, Dec 2-6th 2018, Anaheim Smith M, Antimisiaris D, Polivka B, Folz R, Endicott D. Impact of Polypharmacy Skin Prick Testing in Older Adults.


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