Cargando…

Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data

OBJECTIVE: To determine if a prototype pharmacists’ services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists’ performance can be used to identify characteristics of pharmacies providing higher quality of care. DESIGN: Population-b...

Descripción completa

Detalles Bibliográficos
Autores principales: Winslade, Nancy, Tamblyn, Robyn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623573/
https://www.ncbi.nlm.nih.gov/pubmed/28939571
http://dx.doi.org/10.1136/bmjopen-2017-015877
_version_ 1783268119932829696
author Winslade, Nancy
Tamblyn, Robyn
author_facet Winslade, Nancy
Tamblyn, Robyn
author_sort Winslade, Nancy
collection PubMed
description OBJECTIVE: To determine if a prototype pharmacists’ services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists’ performance can be used to identify characteristics of pharmacies providing higher quality of care. DESIGN: Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010. SETTING: All community pharmacies in Quebec, Canada. PARTICIPANTS: 1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients. PRIMARY OUTCOME MEASURE: Patient adherence to antihypertensive medications. PREDICTORS: Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering. RESULTS: 9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists’ services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains. CONCLUSIONS: Pharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist’s professional services and continuity of pharmacist’s care.
format Online
Article
Text
id pubmed-5623573
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-56235732017-10-10 Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data Winslade, Nancy Tamblyn, Robyn BMJ Open Health Services Research OBJECTIVE: To determine if a prototype pharmacists’ services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists’ performance can be used to identify characteristics of pharmacies providing higher quality of care. DESIGN: Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010. SETTING: All community pharmacies in Quebec, Canada. PARTICIPANTS: 1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients. PRIMARY OUTCOME MEASURE: Patient adherence to antihypertensive medications. PREDICTORS: Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering. RESULTS: 9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists’ services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies belonging to different banners and chains. CONCLUSIONS: Pharmacy administrative claims data can be used to calculate pharmacy-level characteristics associated with improved quality of care. This study supports the importance of pharmacist’s professional services and continuity of pharmacist’s care. BMJ Publishing Group 2017-09-21 /pmc/articles/PMC5623573/ /pubmed/28939571 http://dx.doi.org/10.1136/bmjopen-2017-015877 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Health Services Research
Winslade, Nancy
Tamblyn, Robyn
Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title_full Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title_fullStr Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title_full_unstemmed Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title_short Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
title_sort determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
topic Health Services Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623573/
https://www.ncbi.nlm.nih.gov/pubmed/28939571
http://dx.doi.org/10.1136/bmjopen-2017-015877
work_keys_str_mv AT winsladenancy determinantsofcommunitypharmacistsqualityofcareapopulationbasedcohortstudyusingpharmacyadministrativeclaimsdata
AT tamblynrobyn determinantsofcommunitypharmacistsqualityofcareapopulationbasedcohortstudyusingpharmacyadministrativeclaimsdata