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continued from previous page ■ Promoting effective communication and coordination
of care. ■ Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. ■ Working with communities to promote wide use of best practices to enable healthy living. ■ Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models. While these priorities are general in nature, one current area of more intense focus for PQA is medication adherence. We all know that medication adherence is a significant problem that simply has not yet been solved. So what might the efforts in this area mean for community pharmacy practice? We have spoken with some of your colleagues, and many have been largely unaware of PQA’s work. After learning about the alliance’s efforts, the general consensus is in agreement that much work remains to be done to improve medication-related outcomes for patients in the community. Adherence is considered to be a good place to start. A quick scan of the PQA site (http://pqaalliance.org/ measures/default.asp) reveals what constitutes the measures of adherence. The site, in an apparent spirit of transparency, lists all current measures as well as those under consideration. Other measures address medication use quality in terms of the presence of drug-drug interactions, the use of medications in high-risk populations, and clinical guideline adherence. Like us, those who review the measures will likely find them sound and to reflect goals that we should strive for in community pharmacy practice.
The Challenges We anticipate two primary challenges with the measures. One is technical and the other is not. The technical challenge is the development of a mechanism to efficiently and accurately capture, analyze, and share the data that make up the measures. If the goal is to look at quality in a broad swath of community pharmacy practice, then quality measurement data must of course come from a diverse representation of practice. Put another way, if quality measurement data are going to reflect practice, they should originate in a variety of practice settings. Additionally, these data would ideally be captured, stored, and transmitted, in a structured manner that allows interoperability between the systems where they originate and the analytic and reporting systems 38
ComputerTalk
where they become meaningful. Understandably, users (payers, pharmacists, etc.) must have confidence in the system’s security. PQA has developed a platform to perform these tasks. Visit www.equipp.org to learn more about the Electronic Quality Improvement Platform for Plans & Pharmacies. On the site, you will see that the platform is designed to provide standardized, unbiased performance data on agreed-upon quality metrics. Benchmarking is provided to allow participants to identify where they fit compared to their peer group. As we write this on the 20th birthday of the World Wide Web, we have to smile at the capabilities provided by the most important graphical user interface the world has known. As is often the case with technology-based solutions for practice-related issues, the larger challenge may not be technical. PQA describes a future state in which the EQuIPP system will help providers and payers identify and strategize methods to address deficiencies in quality of medication use. The goal is to create an efficient quality feedback system that enables pharmacists to identify opportunities for quality improvement and track their performance as they implement changes in their practice. This approach fits with the move toward value-driven care and the growing trend of performance-based payments for providers. Community pharmacists should anticipate that a portion of their payment in the future would be dependent on achieving quality targets related to medication adherence and safety. The concern expressed by some is that the platform could simply be additional “paperwork” (albeit electronic) for pharmacies, and that the system will be used to penalize pharmacies for not achieving quality instead of rewarding for quality that is achieved. Many of the measures we have mentioned can be gathered as a byproduct of analyzing the transactions performed by your pharmacy management system, and flags can be generated in exception reports. EQuIPP does not require any additional paperwork or reporting by pharmacies, since the measures are calculated with existing data. Our crystal ball does not tell us what will happen. Available information suggests broad stakeholder participation in the initiative. Our hearts truly hope that the initiative will lead to advanced status for pharmacists and new avenues of reimbursement. Active involvement in one (or more) of the participating organizations is the best way to have your voice heard. We also encourage you to let us know what you think. CT Brent I. Fox, Pharm.D., Ph.D., is an associate professor, and Bill G. Felkey, M.S., is professor emeritus, in the Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University. They can be reached at foxbren@auburn.edu and felkebg@auburn.edu.