Anne Andrews
1. Your research interests include many aspects of asthma care including controller medication use. You even studied using smartphones to improve adherence to asthma care. If you had a magic wand, what is one thing you would have all patients do to improve their asthma care? What about the medical providers?
Asthma is an incredibly challenging disease to manage, both for providers and patients/caregivers. I believe that one of the reasons it feels so frustrating for us is that, for most children with asthma, we have medications that can treat their disease effectively, prevent exacerbations and improve their quality of life. However, the barriers to achieving this level of disease control are numerous. First, patients have to recognize and report their symptoms. Providers then have to appropriately prescribe controller medications. Patients and caregivers then have to be taught how to effectively deliver these medications. Then we have to rely on patients and their caregivers to remember to take their medications twice a day, every day, even when they are feeling well. One solution that is fully within our control as pediatric hospitalists is to ensure that we ALWAYS prescribe controller medications prior to hospital discharge. We also must ensure appropriate asthma education that includes inhaler technique is provided. We need to provide refills. Why put up yet another barrier for families? If they use up the first canister but then have to call the pharmacy, the primary care physician and drive to the pharmacy to pick it up, adherence is going to decrease. Patient-centered care includes doing these small things that can make our patients’ lives easier.
Another solution is to work to find systematic ways to identify the highest risk patients BEFORE they show up in our hospitals. This will allow us to target time intensive, costly interventions to the patients who will benefit most. That is the focus of my current research. I am excited about the future of asthma risk prediction and the impact it could have on disease control, utilization and quality of life.
2. As an Academic Generalist Fellow at MUSC from 2009-2011, you earned your MSCR. What is that?
It is a Master of Science in Clinical Research. It is a longstanding degree program at MUSC that is targeted to clinicians who aspire to become clinician researchers. It is meant to give the clinician the knowledge and skills needed to lead a research team. In this degree program I took classes in biostatistics, epidemiology, bioethics, statistical software programming, cost-effectiveness analysis and grant writing. It gave me the foundation to begin to build a research career. One of the most valuable aspects of this program was that my professors turned into my research mentors. It takes a long time to build an effective research team and participating in this degree program gave me a definite head start.
3. You have been awarded a KL2 Career Development Award and a Doris Duke award. Can you tell us more about these awards and your work that was recognized?
The KL2 award is an institutional Career Development Award. I highly recommend pediatric hospitalists search out similar opportunities at their own institutions. Similar to a K08 or a K23, the KL2 provides you with 75% protected time to conduct your research, under the mentorship of a team of experienced researchers. When you are trying to build your research program, time is everything. It is amazing what you can accomplish with that degree of protected time. One benefit of the institutional K mechanism is that you are immediately introduced to a group of other clinician researchers on your campus which leads to an abundance of peer-mentoring and collaboration opportunities.
Full disclosure, I applied for a K23 and did not get funded before I was awarded the KL2. Rather than give up, as soon as the KL2 position opened up I modified my K23 proposal and applied for the KL2. Always remember, when a door closes, usually a window opens. Research is all about persistence and this certainly applies to obtaining funding. I think sometimes junior pediatric hospitalists and trainees see the successful researchers in our field and think they got there on a path of success after success. You would be surprised to know how many rejected grants you usually have to write before you get one funded. The same concept applies to publishing manuscripts, you will get a lot of rejections. Don’t let it get you down, stay persistent.
The Doris Duke Award was a grant mechanism targeted to clinician researchers with significant commitments outside of work (childcare, elder care etc.). The goal of the program is to retain clinician researchers by giving them extra support during a period of grant funding. While I was on my KL2 I had my second of three children. The Doris Duke award gave me funding to support a data analyst while I was on maternity leave. This allowed my project to continue moving forward even while I had to step away from work for a period of time. I will always be grateful to the Doris Duke Foundation for this. I have no doubt that it contributed significantly to the success of my KL2 research.
4. You have experience with Medicaid data, Truven MarketScan data, and SAS programming skills. Where did you gain these skills, and how do they help you with your role as a pediatric hospitalist?
I began working with Medicaid data during my fellowship and MSCR classes. We are fortunate in South Carolina to have relatively easy access to these data. I quickly realized how many research gaps can be filled with existing data. My institution then purchased the Truven MarketScan data which was a logical place for me to go next. Working with these data is more challenging that a single state’s Medicaid data but it can improve generalizability because it includes children from all over the country.
I learned to program in SAS during my fellowship. I honestly never would have envisioned that this was something I could learn, but I surprised myself and actually really enjoyed being able to write my own code and run my own analyses. I always had mentors I could reach out to when I had trouble, but programming on my own really allowed my research to move forward at a faster pace. Thankfully, I don’t typically have to do my own programming anymore, but I do get a bit nostalgic when I see my fellows working through their own code.
5. You have a passion for gun violence prevention—how did that come about? What can pediatric hospitalists do to help?
This passion came up completely organically and surprised me as much as anyone else. A few days after the shooting at Marjory Stoneman Douglas High School in Parkland, Florida, I was dropping off my oldest daughter in the Kindergarten drop-off line. As she was getting out of the car, I noticed an armed police officer patrolling the front of the school. I will never forget that visual and that sinking feeling I had. What kind of world am I sending my daughter into? I went home and called my elected officials to tell them how I was feeling and what I thought they should do about it. I started crying on the phone, which was very out of character for me. I knew I had to do more than live in fear and anger and periodically leave messages for my Senators. So, I went to a Moms Demand Action meeting. I thought that going to one meeting might help me feel more in control. My education on the public health crisis of gun violence began that evening in that small meeting room with about eight members of my local Moms Demand Action chapter.
I quickly learned that gun violence is the second leading cause of death among children and the leading cause of death for black children in our country. Gun deaths fall into 3 categories: homicide, suicide and unintentional shootings (when a child gains access to an unsecured gun and unintentionally pulls the trigger, injuring him/herself or someone else). Each of these types of gun deaths requires different multi-faceted solutions. Why hadn’t I learned more about this in medical school or residency? What can I do now to help?
Thankfully, the leaders of my local Moms Demand Action chapter knew just how I could help them. They have a national gun safety campaign, Be SMART for Kids (besmartforkids.org) that focuses on educating adults about keeping guns locked, unloaded and separate from ammunition. They had been trying for years to form a relationship with our Department and Children’s Hospital. So that’s what we did. We have had tremendous success at MUSC with increasing the rate of gun safety discussions in our resident clinic. This effort was led by Dr. Kelsey Gastineau, a current PGY-3 and soon to be PHM fellow at Vanderbilt. One of the barriers Kelsey and I have encountered is a question of relevance to our practice as hospitalists. The short answer to that question is yes, it is relevant to our practice. We are all pediatricians and we all want kids to grow up healthy and safe. Every patient encounter is an opportunity to promote safe gun storage practices, which can ultimately decrease rates of firearm injury in children. The long answer can be found here: https://hosppeds.aappublications.org/content/10/1/98.long.
6. What advice do you have for those who want to become physician advocates?
Start small, find your passion, connect with existing community organizations. Don’t give up. As physicians we have agency. People listen to what we have to say. There are some incredible advocates in our field, follow their lead. I can say with 100% certainty that my work in advocacy and gun violence prevention has been by far the most rewarding work of my career. I encourage anyone who has any interest in wading into this area to give it a try. I have no advanced training in advocacy, I have educated myself, formed strategic partnerships and let my passion drive me. Dr. Samir Shah gave me the opportunity to write a perspective on physician advocacy for the Journal of Hospital Medicine (https://www.journalofhospitalmedicine.com/jhospmed/article/210069/hospital-medicine/turning-your-passion-action-becoming-physician-advocate) and I encourage you all to read it if you are feeling like you want to do more to advocate for children.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Your career is a marathon not a sprint. It can and should take unexpected twists and turns. Follow your passions and remember that we only have one chance at this so do what makes you happy.
Asthma is an incredibly challenging disease to manage, both for providers and patients/caregivers. I believe that one of the reasons it feels so frustrating for us is that, for most children with asthma, we have medications that can treat their disease effectively, prevent exacerbations and improve their quality of life. However, the barriers to achieving this level of disease control are numerous. First, patients have to recognize and report their symptoms. Providers then have to appropriately prescribe controller medications. Patients and caregivers then have to be taught how to effectively deliver these medications. Then we have to rely on patients and their caregivers to remember to take their medications twice a day, every day, even when they are feeling well. One solution that is fully within our control as pediatric hospitalists is to ensure that we ALWAYS prescribe controller medications prior to hospital discharge. We also must ensure appropriate asthma education that includes inhaler technique is provided. We need to provide refills. Why put up yet another barrier for families? If they use up the first canister but then have to call the pharmacy, the primary care physician and drive to the pharmacy to pick it up, adherence is going to decrease. Patient-centered care includes doing these small things that can make our patients’ lives easier.
Another solution is to work to find systematic ways to identify the highest risk patients BEFORE they show up in our hospitals. This will allow us to target time intensive, costly interventions to the patients who will benefit most. That is the focus of my current research. I am excited about the future of asthma risk prediction and the impact it could have on disease control, utilization and quality of life.
2. As an Academic Generalist Fellow at MUSC from 2009-2011, you earned your MSCR. What is that?
It is a Master of Science in Clinical Research. It is a longstanding degree program at MUSC that is targeted to clinicians who aspire to become clinician researchers. It is meant to give the clinician the knowledge and skills needed to lead a research team. In this degree program I took classes in biostatistics, epidemiology, bioethics, statistical software programming, cost-effectiveness analysis and grant writing. It gave me the foundation to begin to build a research career. One of the most valuable aspects of this program was that my professors turned into my research mentors. It takes a long time to build an effective research team and participating in this degree program gave me a definite head start.
3. You have been awarded a KL2 Career Development Award and a Doris Duke award. Can you tell us more about these awards and your work that was recognized?
The KL2 award is an institutional Career Development Award. I highly recommend pediatric hospitalists search out similar opportunities at their own institutions. Similar to a K08 or a K23, the KL2 provides you with 75% protected time to conduct your research, under the mentorship of a team of experienced researchers. When you are trying to build your research program, time is everything. It is amazing what you can accomplish with that degree of protected time. One benefit of the institutional K mechanism is that you are immediately introduced to a group of other clinician researchers on your campus which leads to an abundance of peer-mentoring and collaboration opportunities.
Full disclosure, I applied for a K23 and did not get funded before I was awarded the KL2. Rather than give up, as soon as the KL2 position opened up I modified my K23 proposal and applied for the KL2. Always remember, when a door closes, usually a window opens. Research is all about persistence and this certainly applies to obtaining funding. I think sometimes junior pediatric hospitalists and trainees see the successful researchers in our field and think they got there on a path of success after success. You would be surprised to know how many rejected grants you usually have to write before you get one funded. The same concept applies to publishing manuscripts, you will get a lot of rejections. Don’t let it get you down, stay persistent.
The Doris Duke Award was a grant mechanism targeted to clinician researchers with significant commitments outside of work (childcare, elder care etc.). The goal of the program is to retain clinician researchers by giving them extra support during a period of grant funding. While I was on my KL2 I had my second of three children. The Doris Duke award gave me funding to support a data analyst while I was on maternity leave. This allowed my project to continue moving forward even while I had to step away from work for a period of time. I will always be grateful to the Doris Duke Foundation for this. I have no doubt that it contributed significantly to the success of my KL2 research.
4. You have experience with Medicaid data, Truven MarketScan data, and SAS programming skills. Where did you gain these skills, and how do they help you with your role as a pediatric hospitalist?
I began working with Medicaid data during my fellowship and MSCR classes. We are fortunate in South Carolina to have relatively easy access to these data. I quickly realized how many research gaps can be filled with existing data. My institution then purchased the Truven MarketScan data which was a logical place for me to go next. Working with these data is more challenging that a single state’s Medicaid data but it can improve generalizability because it includes children from all over the country.
I learned to program in SAS during my fellowship. I honestly never would have envisioned that this was something I could learn, but I surprised myself and actually really enjoyed being able to write my own code and run my own analyses. I always had mentors I could reach out to when I had trouble, but programming on my own really allowed my research to move forward at a faster pace. Thankfully, I don’t typically have to do my own programming anymore, but I do get a bit nostalgic when I see my fellows working through their own code.
5. You have a passion for gun violence prevention—how did that come about? What can pediatric hospitalists do to help?
This passion came up completely organically and surprised me as much as anyone else. A few days after the shooting at Marjory Stoneman Douglas High School in Parkland, Florida, I was dropping off my oldest daughter in the Kindergarten drop-off line. As she was getting out of the car, I noticed an armed police officer patrolling the front of the school. I will never forget that visual and that sinking feeling I had. What kind of world am I sending my daughter into? I went home and called my elected officials to tell them how I was feeling and what I thought they should do about it. I started crying on the phone, which was very out of character for me. I knew I had to do more than live in fear and anger and periodically leave messages for my Senators. So, I went to a Moms Demand Action meeting. I thought that going to one meeting might help me feel more in control. My education on the public health crisis of gun violence began that evening in that small meeting room with about eight members of my local Moms Demand Action chapter.
I quickly learned that gun violence is the second leading cause of death among children and the leading cause of death for black children in our country. Gun deaths fall into 3 categories: homicide, suicide and unintentional shootings (when a child gains access to an unsecured gun and unintentionally pulls the trigger, injuring him/herself or someone else). Each of these types of gun deaths requires different multi-faceted solutions. Why hadn’t I learned more about this in medical school or residency? What can I do now to help?
Thankfully, the leaders of my local Moms Demand Action chapter knew just how I could help them. They have a national gun safety campaign, Be SMART for Kids (besmartforkids.org) that focuses on educating adults about keeping guns locked, unloaded and separate from ammunition. They had been trying for years to form a relationship with our Department and Children’s Hospital. So that’s what we did. We have had tremendous success at MUSC with increasing the rate of gun safety discussions in our resident clinic. This effort was led by Dr. Kelsey Gastineau, a current PGY-3 and soon to be PHM fellow at Vanderbilt. One of the barriers Kelsey and I have encountered is a question of relevance to our practice as hospitalists. The short answer to that question is yes, it is relevant to our practice. We are all pediatricians and we all want kids to grow up healthy and safe. Every patient encounter is an opportunity to promote safe gun storage practices, which can ultimately decrease rates of firearm injury in children. The long answer can be found here: https://hosppeds.aappublications.org/content/10/1/98.long.
6. What advice do you have for those who want to become physician advocates?
Start small, find your passion, connect with existing community organizations. Don’t give up. As physicians we have agency. People listen to what we have to say. There are some incredible advocates in our field, follow their lead. I can say with 100% certainty that my work in advocacy and gun violence prevention has been by far the most rewarding work of my career. I encourage anyone who has any interest in wading into this area to give it a try. I have no advanced training in advocacy, I have educated myself, formed strategic partnerships and let my passion drive me. Dr. Samir Shah gave me the opportunity to write a perspective on physician advocacy for the Journal of Hospital Medicine (https://www.journalofhospitalmedicine.com/jhospmed/article/210069/hospital-medicine/turning-your-passion-action-becoming-physician-advocate) and I encourage you all to read it if you are feeling like you want to do more to advocate for children.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Your career is a marathon not a sprint. It can and should take unexpected twists and turns. Follow your passions and remember that we only have one chance at this so do what makes you happy.