Monitoring and Reporting Quality Performance and Medication Safety in Community Pharmacy

1. Monitoring and Reporting Quality Performance and Medication Safety in Community Pharmacy

2. Overview • This educational material is to assist you in viewing and interpreting your pharmacy performance reports as part of the Purdue University demonstration project. • After reading this material, proceed to your individual store pharmacy quality measures (Your Pharmacy Quality Measures link). View your results and let the investigators know if you have any questions using the “Contact Us” link. • When you have viewed your individual store report, complete the feedback survey to let the investigators know your thoughts on the website.

3. Patient Provider Payer Assessing Health Care Quality Concerns about quality are different based on the stakeholders. Stakeholders may have different, as well as overlapping priorities in regards to quality. However, a high quality system must be: • safe • effective • patient-centered • timely • efficient • equitable Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.

4. Changing to a High Quality Health Care System Many different organizations are changing the quality of the Health Care System: Evidence-based Medicine: Guideline Developers: • Associations • AHA/ACC • AMA • (Many others!) • ADA • AHA Guideline Development Measure Development • NCQA • JCAHO • AHRQ • Health Plans • Prof. Associations • AHA/ACC • Others (PQA) Measure Endorsement National Quality Forum (NQF) Consensus Development Process Measure Selection for Public Reporting, Pay for Reporting Pay for Performance • CMS, AHRQ • Alliances(HQA, AQA, PQA) • The LeapFrog Group • Bridges to Excellence • Other collaborative P4P/P4R

5. Patient Compliance rates Optimal asthma therapy Optimal diabetes care management Appropriate medications for the elderly Patient satisfaction-clinical care oriented Today Pharmacy Performance Measures • Number of prescriptions filled/day • Generic conversion • Prescriptions filled per unit of time • Labor Cost per prescription • Rx sales • New/Refill prescription ratio • Patient Satisfaction – convenience oriented Future Expanding Measurement to focus on “Quality of Pharmacy Services” will help to promote the pharmacist as a key patient care provider who assures appropriate medication use. Reprinted with permission of .PQA. Warholak, West, and Holdford, EPIQ program, 2008.

6. Pharmacy Quality Alliance (PQA) • Includes over 60 member organizations in the U.S. • Started by a collaborative of the federal government (CMS*) and private organizations (ie. AHIP**) a with the goal to develop and report quality/efficiency measures of pharmacy/pharmacists services. • Is a membership-based, self-sustaining, consensus-driven, organization. • Funded 5 demonstration projects to determine the feasibility of using a starter set of expanded quality performance measures of pharmacy services. *Center for Medicare and Medicaid Services **America’s Health Insurance Plans

7. Demonstration Project • Purdue University received funding from PQA for a demonstration project focused on central Indiana community pharmacies. • Project consists of: • PQA Developed and Endorsed Quality Performance Measures. • Retrospective analysis of prescription claims data. • Patient experience (satisfaction) survey. • Web-based performance reports. • For this project: • All quality reports are password protected and confidential. • Authorized pharmacists only can view their own pharmacy reports. • Reports do NOT affect individual or store performance evaluations.

8. PQA Endorsed Performance Measures • Proportion  of  Days  Covered  (PDC) • Percent of patients who met threshold of 80 percent or have medication available to them for 80% of the days covered by the prescription • Reported for:  Beta  Blockers , ACEI/ARB, Calcium Channel Blockers, Dyslipidemia Medications, Diabetes Mediations  (Sulfonylureas, Biguanides, TZDs) • Gap  in  Therapy • Percent of patients who were dispensed at least 2 prescriptions in a specific therapeutic category who experienced a gap in medication therapy of greater than or equal to 30 days • Reported for: Beta  Blockers , ACEI/ARB, Calcium Channel Blockers, Dyslipidemia Medications, Diabetes Mediations  (Sulfonylureas, Biguanides, TZDs) • Diabetes:  Excessive  Doses  of  Oral  Medications • Percent of patients who were dispensed a dose higher than the daily recommended dose for biguanides, sulfonlyureas, and thiazolidinediones

9. PQA Endorsed Performance Measures Cont. • Diabetes:  Suboptimal  Treatment  of  Hypertension • Percent of patients who were dispensed a medication for diabetes and hypertension who are not receiving an ACEI or ARB medication • Asthma:   Suboptimal  Control • Percent of patients with persistent asthma who were dispensed more than 5 canisters of a short acting beta2 agonist inhaler during the same 3 month period • Asthma:   Absence  of  Controller  Therapy • Percent of patients with persistent asthma who were dispensed more than 5 canisters of short acting beta2 agonist inhalers over a 90 day period who did not receive controller therapy during the same 90-day period

10. How is the data obtained for the performance measure reports Pharmacy Store Store ReportCards Rx Claims Pharmacy Store Store ReportCards Payer Data regarding Rx Claims Regenstrief Institute Data Analysis Pharmacy Store Store ReportCards Rx Claims Pharmacy Store Store ReportCards

11. Performance Report Website: http://www.IndianaPharmacyCompare.org If you have questions or comments Survey to report your opinions of the website Measurement Period Pull-down to see your store characteristics (demographics) Estimate of the percent of patients qualifying for the measure that only used your store for prescriptions of this medication type

12. Performance Report Website:http://www.IndianaPharmacyCompare.org Your store performance (number of patient meeting criteria/potential patients eligible) Describes the desired outcome Pull-down to see definitions Denotes an improvement opportunity or individual store percentage does not meet the average Individual store ranking based on participating pharmacies

13. I have seen the performance measures. Now what? • What are ways to improve compliance? • Identify patients with late refills and discuss any concerns • Develop “registries” of patients that are late to refill • Telephone, mail, email, text contacts for reminders • What are ways to improve therapy? • Offer services such as “brown bag” discussions • Use your employer’s innovative programs • Pay attention to alerts and act on them • Simplify drug regimens • Change medication dosing to “once daily” if possibleAct on therapy duplicates • Contact physicians when patient therapy could be maximized

14. I have seen the performance measures and I have questions Kimberly S. Plake, PhD, RPh Purdue University (765) 494-5966 kplake@purdue.edu Carol Birk, MS, RPh PharmaTAP (317) 698-9026 cebirk@purdue.edu