Monitoring community pharmacist's quality of care: a feasibility study of using pharmacy claims data to assess performance.
BACKGROUND
Public 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.


METHODS
Information 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.


RESULTS
Reliable 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.


CONCLUSIONS
Routinely 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.
Department of Medicine, Faculty of Medicine, McGill University, 1140 Pine Avenue West, H3A 1A3 Montreal, Quebec, Canada. nancy.winslade@mcgill.ca
Nancy
N
Winslade
Laurel
L
Taylor
Sherry
S
Shi
Lambert
L
Schuwirth
Cees
C
Van der Vleuten
Robyn
R
Tamblyn
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001569:Benzodiazepines; D003157:Community Pharmacy Services / Q000592:standards*; D000075202:Contraindications; D016208:Databases, Factual; D017723:Drug Utilization Review; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011787:Quality of Health Care; D011792:Quebec; D012140:Respiratory Tract Diseases / Q000188:drug therapy
D000319:Adrenergic beta-Antagonists; D018927:Anti-Asthmatic Agents; D000959:Antihypertensive Agents; D001569:Benzodiazepines
BMJ. 1999 Oct 30;319(7218):1188-90
10541516
Am J Pharm Educ. 2007 Feb 15;71(1):15
17429515
CMAJ. 2008 Jun 3;178(12):1563-9
18519904
BMJ. 2003 Apr 5;326(7392):753-5
12676847
Am J Hosp Pharm. 1993 Jan;50(1):126-8
8427270
J Contin Educ Health Prof. 2008 Fall;28 Suppl 1:S4-10
19058254
J Clin Epidemiol. 1995 Aug;48(8):999-1009
7775999
Ann Pharmacother. 2008 Jul;42(7):1017-25
18594048
JAMA. 2003 Sep 3;290(9):1183-9
12953001
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):604-10
8118625
Am J Hosp Pharm. 1989 May;46(5):929-44
2729301
CMAJ. 1999 Nov 30;161(11 Suppl):S1-61
10906907
N Engl J Med. 1992 Feb 20;326(8):501-6
1346340
Qual Saf Health Care. 2003 Aug;12(4):280-5
12897361
Int J Qual Health Care. 2003 Dec;15 Suppl 1:i49-59
14660523
N Engl J Med. 2006 Jul 27;355(4):375-84
16870916
Ann Pharmacother. 2007 Sep;41(9):1411-26
17666582
Health Serv Res. 2006 Dec;41(6):2238-54
17116118
Am J Hosp Pharm. 1990 Mar;47(3):533-43
2316538
Drug Intell Clin Pharm. 1984 Dec;18(12):992-6
6510226
JAMA. 2009 Nov 11;302(18):2008-14
19903922
Med Educ. 2002 Oct;36(10):942-8
12390462