About

Richard Segal, Ph.D., is a professor of Pharmaceutical Outcomes & Policy at the University of Florida College of Pharmacy and holds a faculty appointment in the Department of Pharmacotherapy and Translational Research. His research focuses on improving the quality and safety of the medication use process, with particular emphasis on enhancing prescribing practices and developing collaborative practice models to improve medication use by patients. He is widely recognized for his work in explaining why clinical practice often diverges from evidence-based best practices, and his research on changing prescribing behavior has served as the basis for prescribing interventions worldwide. Segal was Co-Principal Investigator on the Therapeutic Outcomes Monitoring (TOM) project, the first major research initiative aimed at training community pharmacists to identify and prevent drug-related problems contributing to preventable drug-related morbidity. His work has influenced many medication therapy management interventions used by health plans in the United States and internationally. In addition to his research, he serves as Associate Chair and Director of Graduate Studies at the University of Florida. His academic background includes a Ph.D. from Virginia Commonwealth University-Medical College of Virginia, an M.Sc. from the University of Iowa, and a B.S. from the University of Connecticut. He also completed an ASHP-accredited residency in hospital pharmacy at Mayo Clinic.

Research topics

• Medicine
• Demography
• Family medicine
• Surgery
• General surgery
• Internal medicine
• Psychiatry

Selected publications

• Evaluating a Community Health Worker Training Program for Medication Adherence Support

  AJPM Focus · 2025-03-26 · 1 citations

  articleOpen access1st authorCorresponding

  Introduction: Medication nonadherence significantly contributes to poor health outcomes and increased healthcare costs, particularly in chronic diseases like hypertension. Community Health Workers (CHWs) are well-positioned to address adherence barriers but often lack specific training in medication management and particularly in improving medication adherence. The objective of this study is to evaluate a training program for CHWs focused on medication adherence support for patients with hypertension. Methods: The study team designed a comprehensive training program consisting of pre-recorded lectures and a 2-day live session. The live training content included didactic lectures integrated with hands-on practice cases and small group breakout sessions. The program was evaluated using pre and posttests assessing knowledge and self-efficacy. A quality improvement process was implemented post-training to support CHWs in their new roles. Results: <0.001). Self-efficacy scores showed significant improvement across all measured domains. Conclusions: This structured training program effectively improved CHWs' knowledge and confidence in supporting medication adherence. This approach shows promise for enhancing CHWs' roles in collaborating with healthcare professionals for chronic disease management.

  PublisherOA PDFDOI

• Examining the relationship between adherence and the number of cardiometabolic medications: Findings for patients with type 2 diabetes within a Tribal health care system

  Journal of Managed Care & Specialty Pharmacy · 2025-05-30

  articleOpen access

  BACKGROUND: The literature is inconclusive regarding the association between adherence and the number of concurrent prescribed medications. Among patients with type 2 diabetes (T2D), low medication adherence is linked with inadequate glycemic management and increased diabetes-related complications. Adherence to glucose-lowering, lipid-lowering, and antihypertensive medications may be impacted by the number of cardiometabolic medications taken by adults with T2D, including American Indian adults. OBJECTIVE: To examine the association between medication adherence and the number of cardiometabolic medications among American Indian adults with T2D using Tribal health services, a health care system where all medical care and medications are provided free of charge. METHODS: We used 2019 medication dispensing data and patient data from the electronic health records of the Choctaw Nation Health Services Authority. Our sample included 6,774 American Indian adults aged 20 years and older, previously diagnosed with T2D, who received at least 1 cardiometabolic medication from a Choctaw Nation Health Services Authority pharmacy. We measured medication adherence as the proportion of days covered (PDC; possible range 0-1). Analysis of variance and chi-square tests were used to examine the association between the number of medications and patient characteristics. Multiple linear regression was used to estimate the association of adherence with patient characteristics. RESULTS: < 0.001). CONCLUSIONS: To our knowledge, this is the first study demonstrating the association between a higher number of cardiometabolic medications and better adherence in American Indian adults diagnosed with T2D whose medications were provided without cost to the patients. Medication cost is a well-known medication adherence barrier. Future studies should further examine factors associated with nonadherence in this population, such as younger age and fewer medications.

  PublisherOA PDFDOI

• HMG Co-A reductase inhibitor medication management in American Indians with type 2 diabetes: A multiyear view from a rural tribal health system

  Journal of the American Pharmacists Association · 2025-08-07

  articleOpen access
  PublisherOA PDFDOI

• Enhancing medication adherence in marginalized and minoritized communities: A brief training approach for pharmacy technicians and community health workers

  Exploratory Research in Clinical and Social Pharmacy · 2025-02-19 · 2 citations

  articleOpen access1st authorCorresponding

  Background: Medication non-adherence is a pervasive issue, with especially severe consequences for marginalized and minoritized populations. Engaging pharmacy technicians and community health workers (CHWs) to address medication adherence in collaboration with pharmacists could be an effective strategy since they may be better positioned to build trust and rapport with patients compared to pharmacists alone. Objectives: This study aimed to evaluate and compare the effectiveness of a brief training program for pharmacy technicians and community health workers in improving medication adherence. Methods: A hybrid model training program, including pre-recorded video lectures to be watched at home followed by an in-person session, was developed and delivered to 19 pharmacy technicians and 109 CHWs, focusing on key skills related to enhancing medication adherence. Participants' knowledge and self-efficacy were assessed using pre- and post-program questionnaires. Results: The training program yielded significant improvements in participants' knowledge and confidence in performing activities to improve medication adherence. Notably, post-training scores did not differ significantly between pharmacy technicians and community health workers, indicating that both groups achieved similar levels of knowledge and self-efficacy. Furthermore, pharmacy technicians demonstrated significant gains in understanding cultural competence and health disparities. Conclusion: A targeted, brief training program can significantly enhance the knowledge and self-efficacy of pharmacy technicians and community health workers in addressing medication adherence. Engaging these frontline healthcare workers could be a crucial strategy for improving medication adherence, particularly in marginalized communities. Future research is necessary to assess the impact of this training on patient adherence outcomes.

  PublisherDOI

• Medication Engagement, Determinants of Health, and A1C Levels Among Adults With Type 2 Diabetes within a Tribal Health System

  The Science of Diabetes Self-Management and Care · 2024-07-31 · 1 citations

  articleOpen access

  PURPOSE: The purpose of this study was to examine the association between determinants of health, medication engagement, and A1C levels in adults with type 2 diabetes (T2DM) receiving Tribal health and pharmacy services. METHODS: A retrospective analysis of 2020-2021 electronic health record data was conducted and included adult patients with T2DM using Choctaw Nation Health Services Authority prescribed ≥1 noninsulin glucose-lowering medication in 2020, had ≥1 A1C value in 2020 and 2021, and had a valid zip code in 2021. Patients receiving both insulin and other noninsulin glucose-lowering medication were included. The proportion of days covered (PDC) was used to calculate medication engagement. Statistical analyses included bivariate analysis and linear regression. RESULTS: There were 3787 patients included in the analyses; 62.5% were considered engaged (PDC ≥ 0.8). The mean 2020 A1C level was 8.0 (64 mmol/mol) ± 1.8; 33% had an A1C of <7%, 42% had an A1C of 7% to 9%, and 25% had an A1C >9%. The mean A1C in 2021 was 7.9 (63 mmol/mol) ± 1.7; 34% had an A1C of <7%, 44% had an A1C of 7% to 9%, and 22% had an A1C >9%. Older age was weakly correlated with higher engagement; higher engagement was associated with lower A1C levels while adjusting for covariates. CONCLUSIONS: Medication engagement was associated with lower A1C levels, and older age was weakly associated with higher engagement to noninsulin glucose-lowering medications, consistent with previous literature. No determinants of health were significantly associated with A1C levels while adjusting for covariates.

  PublisherOA PDFDOI

• Socioeconomic and Demographic Characteristics of US Adults Who Purchase Prescription Drugs from Other Countries

  UNC Libraries · 2024-01-09

  articleOpen access

  Importance: Little is known about the current use of imported drugs and the factors associated with individual purchase of medications outside the US. Objective: To evaluate the proportion of the US adult population that purchases medications in other countries and the patient factors associated with the behavior. Design, Setting, and Participants: This retrospective cross-sectional study used data from the 2015-2017 National Health Interview Survey. The study sample included 61238 individuals 18 years or older who reported use of prescribed medication by a physician or other practitioner. Data analysis was performed in November 2019. Main Outcomes and Measures: Self-reported experience of purchasing prescription drugs from countries outside the US in the past 12 months. Internet use behaviors for health care included searches for health information and filling of a prescription online. Medication-taking behaviors included skipping or delaying filling a prescription and using alternative therapies to save money. Survey design-adjusted analysis was used to estimate and compare characteristics between those who purchased medications outside the US and those did not. Multivariable logistic regression was fitted to examine the association of medication purchases with internet use and medication-taking behavior factors. Results: Among 61238 US adults taking prescription medications (mean [SD] age, 50.5 [18.5] years; 56.5% female; 70.8% white), the estimated prevalence of purchasing of medication outside the US was 1.5% (95% CI, 1.4%-1.7%; 2.3 million US individuals). Those who purchased medications outside the US were more likely to be older (age >64 years; adjusted odds ratio [aOR], 1.68; 95% CI, 1.24-2.29), to be from Hispanic (aOR, 1.70; 95% CI, 1.23-2.35) or immigrant populations (aOR, 3.20; 95% CI, 2.44-4.20), and to have higher educational attainment (bachelor's degree; aOR, 1.79; 95% CI, 1.27-2.54), lower family income (low income; aOR, 1.41; 95% CI, 1.06-1.87), and lack of insurance (aOR, 3.14; 95% CI, 2.33-4.21). Data analyses indicated that online health information-seeking behavior (aOR, 1.62; 95% CI, 1.33-1.98) or use of an online pharmacy (aOR, 2.30; 95% CI, 1.83-2.90) was associated with a greater likelihood of medication purchases outside the US. Individuals who skipped medications (aOR, 3.86; 95% CI, 3.05-4.88) or delayed filling a prescription (aOR, 4.04, 95% CI, 3.23-5.06) also had higher odds of purchasing medication outside the US. Conclusions and Relevance: The findings suggest that patients are not using prescription purchases outside the US to meet their medication needs. However, monitoring to promote safe administration of medications imported into the US should be continued.

  PublisherDOI

• Abstract 4146613: Dual Trajectories of Allopurinol and Colchicine Use and Cardiovascular Outcomes among Older Adults

  Circulation · 2024-11-12

  article

  Background: Several anti-inflammatory and urate-lowering drugs commonly used in gout have shown promise in reducing cardiovascular risk. However, there remains controversy regarding the benefits of concomitant allopurinol and colchicine in cardiovascular risk prevention, and many previous studies have failed to account for time-varying dose and duration of use for both medications. Thus, we aimed to 1) examine dual trajectories of allopurinol-colchicine use and 2) evaluate risk of major adverse cardiovascular events (MACE) according to trajectories. Methods: Using 2011-2020 Medicare claims, we identified new users of allopurinol. We defined the date of first allopurinol fill as the index date and required continuous enrollment in Medicare Parts A. B, and D for 12 months before and after index date Then, we used group-based multi-trajectory modeling to identify allopurinol and colchicine use patterns by calculating average daily dose for each medication separately during each 2-week period during the first 12 months of allopurinol use. We then constructed inverse probability of treatment weighted Cox survival models to compare time-to-incident MACE across trajectories. Results: We identified 59,429 beneficiaries (mean age: 73.9; 82.6% non-Hispanic white) and ten unique trajectories including: six trajectories with no colchicine use (Trajectory A-F) and four trajectories with colchicine use (Trajectory G-J). Compared to Trajectory A (rapidly decreasing allopurinol - no colchicine), we observed a lower risk for MACE among Trajectories E (~200 mg allopurinol - no colchicine; aHR: 0.89 [95% CI: 0.87-0.92), F (~300 mg allopurinol - no colchicine; aHR: 0.91 [95% CI: 0.89-0.94]), I (~100 mg allopurinol - ~1.2 mg colchine [stable]; aHR: 0.96 [95% CI: 0.93-0.99]), and J (~300 mg allopurinol - gradually decreasing colchicine; aHR: 0.88 [95% CI: 0.85-0.91]). Conclusions: These findings suggest that older adults may benefit from interventions aimed at optimizing dose and duration of allopurinol and colchcine when initiating allopurinol among older adults and further support the need for additional research on the role of concomitant allopurinol and colchicine in cardiovascular risk prevention.

  PublisherDOI

• A Causal Framework for Precision Rehabilitation

  arXiv (Cornell University) · 2024-11-06 · 2 citations

  preprintOpen access

  Precision rehabilitation offers the promise of an evidence-based approach for optimizing individual rehabilitation to improve long-term functional outcomes. Emerging techniques, including those driven by artificial intelligence, are rapidly expanding our ability to quantify the different domains of function during rehabilitation, other encounters with healthcare, and in the community. While this seems poised to usher rehabilitation into the era of big data and should be a powerful driver of precision rehabilitation, our field lacks a coherent framework to utilize these data and deliver on this promise. We propose a framework that builds upon multiple existing pillars to fill this gap. Our framework aims to identify the Optimal Dynamic Treatment Regimens (ODTR), or the decision-making strategy that takes in the range of available measurements and biomarkers to identify interventions likely to maximize long-term function. This is achieved by designing and fitting causal models, which extend the Computational Neurorehabilitation framework using tools from causal inference. These causal models can learn from heterogeneous data from different silos, which must include detailed documentation of interventions, such as using the Rehabilitation Treatment Specification System. The models then serve as digital twins of patient recovery trajectories, which can be used to learn the ODTR. Our causal modeling framework also emphasizes quantitatively linking changes across levels of the functioning to ensure that interventions can be precisely selected based on careful measurement of impairments while also being selected to maximize outcomes that are meaningful to patients and stakeholders. We believe this approach can provide a unifying framework to leverage growing big rehabilitation data and AI-powered measurements to produce precision rehabilitation treatments that can improve clinical outcomes.

  PublisherOA PDFDOI

• Association of Medication Adherence with HbA1c Control among American Indian Adults with Type 2 Diabetes Using Tribal Health Services

  2023-04-17

  preprintOpen access

  &lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;OBJECTIVE&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;To examine HbA1c levels and adherence to oral glucose-lowering medication and their association with future HbA1c levels among American Indian adults with type 2 diabetes (T2D) receiving medication at no-cost from a tribal healthcare system. &lt;/p&gt; &lt;p&gt;&lt;strong&gt;RESEARCH DESIGN AND METHODS&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Tribal citizens with T2D and who used Choctaw Nation Health Services Authority (CNHSA) and Pharmacies and had HbA1c data during 2017-2018 were included in this study. Medication adherence (proportion of days covered [PDC] ≥ 0.80) was calculated using 2017 CNHSA electronic health record data. &lt;/p&gt; &lt;p&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Of the 74,000 tribal citizens living on tribal lands, 4,560 were eligible. 32% had HbA1c at or below target (≤ 7%); 36% were above target (&gt; 7% to ≤ 9%); 32% were uncontrolled (&gt; 9%) in 2017. Percentage of patients with PDC ≥.80 was 66% for Biguanides, 72% for Sulfonylureas, 75% for DPP-4 inhibitors, and 83% for SGLT-2 inhibitors. The proportion of patients with HbA1c at or below target increased slightly from 32% in 2017 to 42% in 2018. Higher average PDC in 2017 was associated with lower HbA1c levels in 2018 (β=-1.143, p&lt;.001).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;CONCLUSION&lt;/strong&gt;&lt;/p&gt; &lt;p&gt;Medication adherence was higher than found in previous studies that used self-report methods in American Indian populations, though a smaller proportion of patients had an HbA1c at or below target relative to US adults with T2D. Mediation adherence was associated with improved HbA1c level for most oral glucose-lowering medication classes. Future studies of American Indians should use both longitudinal prescription data from both electronic health record and pharmacy refill data. &lt;/p&gt;

  PublisherDOI

• Association of Medication Adherence With HbA1c Control Among American Indian Adults With Type 2 Diabetes Using Tribal Health Services

  Diabetes Care · 2023-04-17 · 19 citations

  articleOpen access

  OBJECTIVE: To examine HbA1c levels and adherence to oral glucose-lowering medications and their association with future HbA1c levels among American Indian adults with type 2 diabetes (T2D) receiving medications at no cost from a tribal health care system. RESEARCH DESIGN AND METHODS: Tribal citizens with T2D who used Choctaw Nation Health Services Authority (CNHSA) and Pharmacies and had HbA1c data during 2017-2018 were included in this study. Medication adherence (proportion of days covered [PDC] ≥0.80) was calculated using 2017 CNHSA electronic health record data. RESULTS: Of the 74,000 tribal citizens living on tribal lands, 4,560 were eligible; 32% had HbA1c at or below target (≤7%), 36% were above target (>7 to ≤9%), and 32% were uncontrolled (>9%) in 2017. The percentage of patients with PDC ≥0.80 was 66% for those using biguanides, 72% for sulfonylureas, 75% for dipeptidyl peptidase 4 inhibitors, and 83% for sodium-glucose cotransporter 2 inhibitors. The proportion of patients with HbA1c at or below target increased slightly from 32% in 2017 to 42% in 2018. Higher average PDC in 2017 was associated with lower HbA1c levels in 2018 (β = -1.143; P < 0.001). CONCLUSIONS: Medication adherence was higher than that found in previous studies using self-report methods in American Indian populations, although a smaller proportion of patients had HbA1c at or below target relative to U.S. adults with T2D. Medication adherence was associated with improved HbA1c levels for most oral glucose-lowering medication classes. Future studies of American Indians should use both longitudinal prescription data from both electronic health records and pharmacy refills.

  PublisherOA PDFDOI

Recent grants

• Machine and Electronics Shop Core Unit

  NIH · $26.0M · 2018

Frequent coauthors

• K. Robin Yabroff

  American Cancer Society

  36 shared

• Almut G. Winterstein

  Center for Drug Evaluation and Research

  26 shared

• Jonathan R. Wolpaw

  Neurotech (United States)

  22 shared

• Aiko K. Thompson

  Medical University of South Carolina

  21 shared

• Sholom Wacholder

  18 shared

• William J. Hoskins

  18 shared

• Frederic Kachnic

  National Cancer Institute

  18 shared

• Susan Donehower

  National Cancer Institute

  18 shared