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

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.

Keywords: health policy; hypertension; quality in health care.

Figure 1

Consort diagram. *Dispensings that were provided to patients who had been either adherent or non-adherent with their antihypertensive medication over the previous 90 days. **Patients with at least one adherent dispensing over the 8-month study period. ***Patients with at least one non-adherent dispensing over the 8-month study period. As patients received multiple dispensings, they could be counted as both adherent and non-adherent; therefore, the total of adherent and non-adherent patients is more than 760 700.