Monitoring Community Pharmacist's Quality of Care: A feasibility study of using pharmacy claims data to assess performance

Abstract

BackgroundPublic pressure has increasingly emphasized the need to ensure the continuing quality of care provided by health professionals over their careers. Health profession's regulatory authorities, mandated to be publicly accountable for safe and effective care, are revising their quality assurance programs to focus on regular evaluations of practitioner performance. New methods for routine screening of performance are required and the use of administrative data for measuring performance on quality of care indicators has been suggested as one attractive option. Preliminary studies have shown that community pharmacy claims databases contain the information required to operationalize quality of care indicators. The purpose of this project was to determine the feasibility of routine use of information from these databases by regulatory authorities to screen the quality of care provided at community pharmacies.MethodsInformation from the Canadian province of Quebec's medication insurance program provided data on prescriptions dispensed in 2002 by more than 5000 pharmacists in 1799 community pharmacies. Pharmacy-specific performance rates were calculated on four quality of care indicators: two safety indicators (dispensing of contra-indicated benzodiazepines to seniors and dispensing of nonselective beta-blockers to patients with respiratory disease) and two effectiveness indicators (dispensing asthma or hypertension medications to non-compliant patients). Descriptive statistics were used to summarize performance.ResultsReliable estimates of performance could be obtained for more than 90% of pharmacies. The average rate of dispensing was 4.3% (range 0 - 42.5%) for contra-indicated benzodiazepines, 15.2% (range 0 - 100%) for nonselective beta-blockers to respiratory patients, 10.7% (range 0 - 70%) for hypertension medications to noncompliant patients, and 43.3% (0 - 91.6%) for short-acting beta-agonists in over-use situations. There were modest correlations in performance across the four indicators. Nine pharmacies (0.5%) performed in the lowest quartile in all four of the indicators, and 5.3% (n = 95) performed in the lowest quartile on three of four indicators.ConclusionsRoutinely collected pharmacy claims data can be used to monitor indicators of the quality of care provided in community pharmacies, and may be useful in future to identify underperforming pharmacists, measure the impact of policy changes and determine predictors of best practices.

Quality indicators and community pharmacy services: a scoping review

“…Figure illustrates the study selection and the exclusion/inclusion processes. The studies were conducted in 12 countries, of which three were conducted in the Netherlands, two each in the UK, USA, and Thailand, and one each in Argentina, Spain, Australia, Canada and Brazil . One study was conducted in three countries: Ethiopia, Uganda and Zimbabwe.…”

“…Eleven studies reported the development of quality indicators for community pharmacies . Multiple methods were used to produce initial sets of indicators including literature review, focus groups, surveys, case studies and interviews (Table ).…”

“…Initial sets of indicators were subjected to a selection exercise performed by expert or stakeholder consensus . Testing of psychometric properties included validity, reliability, feasibility and variability …”

“…In Canada, the feasibility of using pharmacy claim data to assess four quality indicators was also evaluated. The indicators included two safety indicators (dispensing of contraindicated benzodiazepines to seniors and dispensing of non‐selective beta‐blockers to patients with respiratory disease) and two effectiveness indicators (dispensing asthma or hypertension medications to non‐compliant patients).…”

Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

“…A very focused quality improvement programme targeting specific clinical practices (ie, DOACs only) would have been less time‐consuming with regard to documentation of clinical information and the training programme. Integrating pharmacy students into the process or collecting information from other sources (eg, claims data, targeting a specific anticoagulation therapy software) could alleviate this barrier. As observed by other PBRNs, the STAT network increased accessibility to the quality improvement programme, especially for pharmacies in remote areas and making it more convenient.…”