Antoinette (Toni) Coe
Antoinette (Toni) B. Coe
Pharm.D., Ph.D., FAPhA
2016-2018 IHPI CLINICIAN SCHOLAR
Assistant Professor of Pharmacy, University of Michigan
Antoinette (Toni) Coe, Pharm.D., Ph.D., FAPhA, is a pharmacist-scientist focused on improving medication-related outcomes and ensuring safe and effective medication use in vulnerable older adults, with an emphasis on those living with dementia and multiple chronic conditions.
Coe’s research examines how healthcare delivery and health policy impact medication use, as well as ways to improve care transitions.
Coe completed her postdoctoral training as a 2016-2018 IHPI Clinician Scholar. “The National Clinician Scholars Program is for nurses and physicians. I had the opportunity, as a pharmacist, to participate in similar programming as an IHPI Clinician Scholar,” she says.
Prior to the CSP, Coe followed a more nontraditional career path. After completing a BA in biology at Washington & Jefferson College in 1996, she spent 10 years as a forensic scientist at the Allegheny County Coroner’s Office, Division of Laboratories, in Pittsburgh, Pennsylvania, and at the Virginia Department of Forensic Science in Richmond, working in their drug analysis sections.
In 2005, Coe returned to school to earn a Pharm.D. from the Virginia Commonwealth University (VCU) School of Pharmacy in 2009. The following year, she completed a PGY-1 Community-Based Pharmacy Practice Residency with VCU School of Pharmacy/Martin’s Pharmacy. Realizing that she loved the research component of her studies, Coe returned to VCU to earn a Ph.D. in pharmaceutical sciences in 2015.
Motivated by her longstanding interest in research to improve medication use in older adults, Coe began working as a graduate research assistant on a Health Resources and Services Administration (HRSA)-funded Nurse Education, Practice, Quality, and Retention Interprofessional Collaborative Practice grant.
As part of her position and her dissertation work, she conducted health services research at interprofessional care coordination clinics within low-income housing in the Richmond area, looking at healthcare use and care coordination measures among low-income older adults. After she graduated, she worked as an evaluation team member with the Virginia Center on Aging and VCU School of Allied Health on a geriatric workforce enhancement program grant through HRSA.
When Coe came to the CSP, she was introduced to a line of research focused on transitions of care in older adults who have an ICU stay, by Theodore "Jack" Iwashyna, M.D., Ph.D., an important program mentor. Iwashyna, a former CSP co-director now at Johns Hopkins, collaborated with Coe on a number of research projects around this topic.
Some of their published findings (in PLOS) revealed important medication problems after hospitalization, and the rate at which older patients resume taking necessary medications and stop taking unnecessary ones prescribed during their hospitalization.
Using a dataset of over 500,000 hospitalizations in the Veterans Affairs Healthcare System among veterans who were discharged after a hospitalization with an ICU admission (with and without a sepsis diagnosis) and no ICU admission, they examined prescription fill rates for two important drugs: statins, cholesterol drugs that are often stopped by care teams during hospitalization, and antipsychotics, which are commonly prescribed for hospital-induced delirium.
This was the first time this type of research had been conducted in a national hospital system. Wide variances were found between hospitals in the rate at which older patients filled these prescriptions within six months after discharge. Statin discontinuation ranged from 10 to 15 percent and new antipsychotic prescription fills from 2 to 4 percent.
“This study provided evidence that during transitions of care, a lot of problems can take place with medications in older adults who have an ICU stay,” Coe says. “Those who are at higher risk with cognitive impairment may be at higher risk for these medication issues, warranting medication reviews after discharge once a patient returns home, whether it be through a pharmacist at their community pharmacy, primary care, ambulatory care clinic, or specialized transition-like care programs such as post-ICU clinics.”
During her last year of the CSP, Coe worked with her mentoring team to submit an application for a Michigan Institute for Clinical and Health Research (MICHR) KL2 grant, which she was subsequently awarded. “This work has continued on with the team I've built, not only in receiving that initial KL2, but in helping to build the foundation for an NIH K08 Career Development Award,” says Coe.
In 2018, after completing the CSP, Coe transitioned to an assistant professor tenure-track faculty position in the Department of Clinical Pharmacy at the U-M College of Pharmacy.
Coe has recently turned her focus to understanding the uptake and effectiveness of Medicare Part D Medication Therapy Management, examining how pharmacist-provided medication reviews and medication management mitigate inappropriate medication use and adverse events among older adults, and identifying community-based strategies and interprofessional models of care to prevent medication-related problems during care transitions.
Coe noted that building on her work in the Medicare Part D Medication Therapy Management space led to opportunities to partner with IHPI’s National Poll on Healthy Aging to administer a module looking at comprehensive medication reviews in older adults, as well as publication in the JAMA Health Forum and The Journals of Gerontology.
Coe has also partnered with the Michigan Region VII Area Agency on Aging to look at outcomes of their community health worker home visits with telehealth pharmacist-provided medication reviews for older adults after a hospitalization.
Coe’s studies have been funded by the National Institute on Aging (NIA), U-M’s NIA-funded Center to Accelerate Population Research in Alzheimer’s, Michigan Region VII Area Agency on Aging, MICHR, American Pharmacists Association, and American Foundation for Pharmaceutical Education.
The recipient of numerous awards, Coe was selected for the 2024 IHPI Emerging Scholars Exchange Program with the University of Pennsylvania Leonard Davis Institute of Health Economics (Penn LDI), and as a 2024 Fellow by the American Pharmacists Association Academy of Pharmaceutical Research and Science.
Coe says that one of the most important elements of her time at CSP was the extraordinary mentorship she received. “I knew that I would have access to amazing mentorship with the Clinician Scholars Program in building a foundation for a successful academic career.”
She still benefits from strong mentoring from her primary K08 mentors Julie Bynum, M.D., M.P.H., and Karen Farris, Ph.D., M.P.A. “I am incredibly thankful for all of their mentorship, guidance, and support from a research, career, and personal perspective.”
“The resources, faculty, and opportunities for research across disciplines at the University of Michigan are unparalleled. I knew if I completed the IHPI Clinician Scholars Program I would be on a positive trajectory.”
– Toni Coe
Coe also keeps in touch with several scholars in her cohort for personal and professional advice, including Sue Anne Bell, Ph.D., FNP-BC, and Thomas Valley, M.D., M.Sc. “We had an early career faculty group that met every other week to discuss projects we were working on, and we continue that mentoring relationship to this day. It has been incredibly helpful,” she says.
Coe is grateful for her time with the CSP. “This experience has been invaluable in my career path. The program provided exceptional training and helped prepare me for a career as a faculty member,” she says. “The resources, faculty, and opportunities for research across disciplines at the University of Michigan are unparalleled. I knew if I completed the IHPI Clinician Scholars Program I would be on a positive trajectory.”