1 / 19

Pharmacy Measures

Pharmacy Measures. Richard A. Hansen, PhD, RPh Department of Health Outcomes Research & Policy Harrison School of Pharmacy. Outline. Pharmacy Quality Alliance (PQA) Overview (http://pqaalliance.org/) Examples of measures Overview of claims-based adherence measures and their interpretation

maggy-howe
Download Presentation

Pharmacy Measures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pharmacy Measures Richard A. Hansen, PhD, RPh Department of Health Outcomes Research & Policy Harrison School of Pharmacy

  2. Outline • Pharmacy Quality Alliance (PQA) • Overview (http://pqaalliance.org/) • Examples of measures • Overview of claims-based adherence measures and their interpretation • Medication possession ratio (MPR) • Proportion of days covered (PDC)

  3. Pharmacy Quality Alliance (PQA) • Non-profit alliance with > 100 organizations, established in 2006 • Establish performance measures to improve quality, some of which have been adopted by CMS • PQA develops medication-use measures in areas such as medication safety, medication adherence and appropriateness • Measures target high-priority areas and gaps in existing performance measure sets • Focus on priorities identified through the National Priorities Partnership and National Quality Strategy 

  4. Example PQA measures • Percentage of patients with PDC > 80% for chronic medications (e.g., BB, ACE, CCB, statin, oral diabetes drugs, etc) • Percentage of children < 5 receiving antipsychotic medications • Diabetes medication dosing higher than daily recommended dose • Diabetes: appropriate treatment for HTN • Medication therapy for persons with asthma

  5. Adherence / Persistence • Adherence: the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen • Persistence: the duration of time from initiation to discontinuation of therapy

  6. Strengths of Claims-Based Adherence Measurement • Generally performs better than self-report • Reasonably parallels reference standards • More timely and economically efficient than other measurement methods • Pharmacy claims data is generally accurate, or at least more accurate than medical claims since no billing intermediary

  7. Key Assumptions • Having medication supply infers a patient is taking the medication as scheduled • No stock-piling, sharing, etc • Days supply is accurate • People refill medications proximal to the end of previous fills • Treatment is chronic, or at least for a defined period of time

  8. Considerations with Claims-Based Adherence Metrics • OTC use • Purchases outside of insurance • Short measurement intervals • Inpatient hospitalizations • Complex medication use • Switching or augmentation • Dose of drug titration • PRN use

  9. Claims-Based Adherence Metrics Index Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 DS: 34 Fill 4 DS: 34 • Adherence for single interval • Adherence over evaluation period* • Non-adherence for evaluation period • Persistence

  10. Adherence Over Evaluation Period Continuous Measure of Medication Acquisition (CMA) Medication Refill Adherence (MRA) Medication Possession Ratio (MPR)* Medication Possession Ratio modified (MPRm)* Proportion of Days Covered (PDC)* Compliance Rate (CR) Refill Compliance Rate (RCR) Days Between Fills Adherence Rate (DBR)

  11. Medication Possession Ratio (MPR) Index Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 DS: 34 Fill 4 DS: 34 Total Days Supplied MPR = Total Days Evaluated MPR: 128/120 = 1.07 (or 1.07:1)

  12. Medication Possession Ratio modified (MPRm) Index (T0) Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 DS: 34 Fill 4 DS: 34 Total Days Supplied MPRm = X 100 (Last Claim Date – First Claim Date) + Last Days Supply 128 MPRm: X 100 = 89% (110 – 0) + 34

  13. Proportion of Days Covered (PDC) Index Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 DS: 34 Fill 4 DS: 34 Total Days Supplied PDC = X 100 (capped at 1) Total Days Evaluated PDC: (128/120) X 100 = 100%

  14. Proportion of Days Covered (PDCm)* Index Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 Day 30 DS: 34 Day 38 Fill 4 DS: 34 Day 96 Day 110

  15. Proportion of Days Covered (PDCm)* Index Days 1-30 Days 31-60 Days 61-90 Days 91-120 Fill 1 DS: 30 Fill 2 DS: 30 Fill 3 Day 30 DS: 34 Day 38 Fill 4 DS: 34 Day 102 Day 110 Days Evaluated – Days without Supply PDC = Total Days Evaluated PDC: (104/120) X 100 = 86.7%

  16. Dichotomous Measure of Adherence • Create indicator for adherent vs. non-adherent based on pre-specified tolerance • Based on period adherence measures • Hard to know what qualifies as “adherent” >= 80% chronic meds >= 95% for HIV • Does this really reflect adherence?

  17. Persistence: Gap Threshold Index • Threshold commonly defined as: • 1.5 times days supply • 7 days (~ MPR of 80% for days supply of 30) • 15 days* Days 1-30 Days 31-60 Days 61-90 Days 91-120 Gap Grace Fill 1 DS: 30 Gap Grace Fill 2 DS: 30 * Gap Grace Fill 3 DS: 34 Fill 4 DS: 34

  18. Combination of Dichotomous Adherence and Gap Limit • Dual requirement for meeting overall adherence threshold with no clinically meaningful gaps in treatment • For example, adherent & persistent: • MPRm >= 80% and no gaps > 15 days

  19. QUESTIONS Contact: rah0019@auburn.edu

More Related