Improving Pharmacy quality: On-site performance measures

Key Points

In late September, presenters at the annual meeting of the Agency for Healthcare Research and Quality (AHRQ) reported their phase 1 evaluation findings for the Pharmacy Quality Alliance (PQA) medication-use demonstration project.

In 2006, start-up funding from the Centers for Medicare and Medicaid Services (CMS) launched the PQA with a mission to "improve the quality of medication use across healthcare settings through a collaborative process in which key stakeholders agree on a strategy for measuring and reporting performance information related to medications."

The current demonstration project is the steppingstone to development of a plan for future implementation of pharmacy reporting processes. These quality reports will help patients, pharmacists, and providers achieve better medication adherence, safety, and quality, as well as greater patient satisfaction.

According to Joyce S. McMahon, PhD, CNA's research director, "Defining pharmacy quality is a challenge; this is a complex area not well studied." Much of it, she said, "depends on what the patient does," in terms of behaviors related to filling and taking medications.

McMahon said the Phase I report of the demonstration project assessed the approach and challenges of the performance measures at the 5 sites using 3 models. Model 1 consisted of a health plan partnered with a community pharmacy corporation and education provider; Model 2 consisted of university-led coalitions of plans, pharmacy organizations, and community pharmacies; and Model 3 consisted of a community pharmacy corporation partnered with a medication therapy management services company. Evaluation data were gathered from all sites and included on-site interviews with the project teams, a survey of pharmacists receiving the quality reports, claims data extracts, and data from a pharmacy consumer survey that was conducted as part of the project.

According to Laura T. Pizzi, PharmD, MPH, associate professor, Jefferson School of Pharmacy, Thomas Jefferson University, and co-director of the Phase I evaluation, "The lessons learned from this project will be useful to designing future tests of pharmacy quality measurement. While several of the sites experienced logistical challenges, our findings indicate that it is feasible to run these quality measures using prescription data to automate reporting and to train pharmacists on interpretation of the resulting reports."

Pizzi added that while refinements will be made to certain measures such as the report template and pharmacist training programs, "The most important next step will be to determine whether pharmacists can successfully intervene with prescribers and patients to improve quality, and what the components of that intervention should be."

McMahon offered another consideration relevant to future implementation. "One thing I would say is that it takes longer to do anything than you think it will," she said, adding that the business agreements, IRB requirements, and legal wrangles connected with obtaining data caused some delays that affected the planned survey and interview schedules. Her recommendation: When future work is initiated, ensure that there is "access to claims data at a point early on in the project."

Accountability in healthcare quality is not a new concept. As the pharmacy profession moves increasingly toward service-related roles, Pizzi said, "It is likely that pharmacists will eventually be held accountable for quality. Therefore, it will be increasingly important for pharmacists to know what healthcare quality is, what pharmacy quality is, and what role pharmacists will play in improving quality as a member of the interdisciplinary healthcare team."

BARBARA HESSELGRAVE is a freelance writer based in Virginia.