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Health services research
Research
Determinants of community pharmacists’ quality of care: a population-based cohort study using pharmacy administrative claims data
  1. Nancy Winslade1,2,
  2. Robyn Tamblyn3
  1. 1 Department of Medicine, McGill University, Montreal, Quebec, Canada
  2. 2 Winslade Consultants, Ottawa, Ontario, Canada
  3. 3 Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Nancy Winslade; nancy.winslade{at}mcgill.ca

Abstract

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.

  • quality in health care
  • hypertension
  • health policy

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/

https://doi.org/10.1136/bmjopen-2017-015877

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    Footnotes

    • Contributors NW and RT conceived and designed the project. NW reviewed literature to determine relevant potential predictors. RT provided expertise on the statistical analysis. NW completed the basic analysis and drafted the manuscript. RT contributed substantially to the manuscript revision. NW redrafted and finalised the manuscript following reviewers’ recommendations. RT contributed substantially to the final revisions.

    • Funding Green Shield Foundation Canada provided a grant for the completion of this project and was both informed of the decision to submit this paper and received a copy of the manuscript. The Quebec Order of Pharmacists provided a matching grant in the form of salary support, facilitated and paid the required data access fees to RAMQ.

    • Competing interests NW reports grants from Green Shield Foundation Canada, personal fees and non-financial support from Quebec Order of Pharmacists during the conduct of the study. RT reports grants from Green Shield Foundation Canada and non-financial support from Quebec Order of Pharmacists during the conduct of the study.

    • Ethics approval McGill University’s Faculty of Medicine Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional unpublished data are available from this study.