Post on 23-Dec-2015
Development of a Wisconsin Pharmacy Practice-based Research Network, using the
WREN Model - Potential Research Collaboration with Both Networks
Betty Chewning, PhD, DirectorMichelle Chui, PharmD, PhDSonderegger Research CenterUW School of Pharmacy
SRC Research History
First academic research center on social and administrative pharmacy internationally (1985)
Primarily NIH, AHRQ, FDA funded research Patient provider decision making/ patient
centered care; drug use behavior; public health (tobacco/ BP); caretaker needs; quality of care; pharmacy ESL needs, workforce, finance, policy
WI Population increased 15% (1990-2008)
WI Population from 1990-2008
4,400,000
4,600,000
4,800,000
5,000,000
5,200,000
5,400,000
5,600,000
5,800,000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Years since 1990
Nu
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# of Pharmacies decreased 6.2% Persons / Pharmacy increased 22%
WI Community Pharmacies from 1990-2008
960
980
1000
1020
1040
1060
1080
1 2 3 4 5 6 7 8 9 10
Years
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ies
Mott, Jenders, 2008
County Summary (1990-2008)
66 of 72 WI counties increased population – 49 increased 10% or more
36 counties decreased number of community pharmacies
– 20 of those 36 had a decrease of 20% or more
31 increased population & decreased community pharmacies
Only Rusk County decreased population & increased pharmacy
What does it mean?
Rural pharmacies are key access point of care for medication users, but busy
Example: the average pharmacy in Bayfield county went from filling an average of 142 prescriptions per day in 1990 to 460 prescriptions per day in 2008
Challenge Now
Identify barriers & facilitators to help busy pharmacists meet health needs more effectively– Quality, efficiency, provider and patient
expectations Identify potential partnerships with clinicians,
public health groups, patients Match health needs of counties with
expertise and access point of pharmacists
State Funded Pharmacy Group Intervention For Tobacco Cessation
RCT of 16 Walgreens pharmacies (30 pharmacists) trained to refer to Tobacco Quit Line, funded by state of WI (Patwardhan, Chewning)
Invaluable Lessons Learned that:– We can work with a group of chain pharmacies– How to prepare sites, develop documentation tools– Chain pharmacies can aid communication, motivate tech and
RPh participation & standardize research protocols Found could train RPh & techs in Walgreens to expand roles,
document intervention consistently, increase referrals to Quit Line, complete data collection (100% pre-post surveys back)
Wisconsin Pharmacy Quality Collaborative (WPQC)
Collaborative between payors and pharmacies called together by the Pharmacy Society of Wisconsin (PSW)
Why? Well over 50% of all Rx orders are not used as intended or prescribed
Goal is to establish a uniform set of pharmacist-provided medication therapy management services and a quality credentialing process
Characteristics of Program– Quality credentialing
– Level I professional services (one-time, point of service)
– Level II professional services (Med therapy management)
– Technology platform through McKesson
– Standardization of requirements, documentation and billing
WPQC Project Status
54 pharmacies (120 pharmacists) enrolled in study – 70,000 lives with current insurers (Central, SE WI)– Waiting on two additional major insurers
Pharmacies must meet 12 “best practice” requirements to participate in network
– Open and show each medication to patient– Continuous Quality Improvement Program– Verifying patient weights for all pediatric meds
Can offer intervention-based services or comprehensive medication review and assessment services
Evaluation of WPQC (Mott PI)
SRC joined with PSW and insurers Goal: To evaluate impact of reimbursing pharmacies
to do comprehensive medication review (level 2) & level 1 services (point-of-care) with patients
Began baseline data collection on RPh self-efficacy; perceived barriers & facilitators
Qualitative analysis of workflow and work system changes
Developing web based surveys with pharmacists willing to do web rather than mail
Data From Claims
Pharmacy level reports Pharmacy level reports can create various
comparisons within WPQC pharmacies as well as with other Wisconsin pharmacies. Data will be aggregated for health plan
Selected pharmacies will be given patient-level reports
Pharmacy Quality Alliance (PQA)
Commissioned by CMS National group working with National Clearinghouse
on Quality Assessment (NCQA) and National Quality Forum
5 Funded Demonstration sites– Wisconsin WPQC project sites, Purdue, North Carolina,
Rite Aid-Pennsylvania
Testing the feasibility of utilizing PQA clinical quality measures for quality credentialing
– Management of specific chronic measures (treatment of ACE-I in diabetic patients, use of high risk meds in elderly)
Pharmacy Quality Alliance (PQA)
WPQC Project and SRC will help PQA to examine:– Ability to calculate QI’s from claims data– Ability to develop a web-based system to educate
pharmacists on performance measurement/ quality
– How well community pharmacists can use web system to understand and take action on QI’s potentially
Why Do We Need A Pharmacy Research Collaborative Network?
Unmet health needs particularly in counties with access issues– Wisconsin has 1200 community pharmacies and
5,000 pharmacists often underused
1st Question is how pharmacy can best help meet health needs of a county
2nd Question is how can pharmacists expand roles to fit with their economic pressures
Building Foundation for Network
Gathering advice from colleagues Using existing data to identify how pharmacy
can best respond to county needs– County health needs, resource profile – County location of community pharmacies– Income, minority profile
Seeking funding through collaborative research and infrastructure support
Implications and Next Steps
Successful research partnerships with groups of pharmacies is possible with both chain and independent pharmacies
Different groups of pharmacies seem drawn to different types of projects depending on:– Research goals– Criteria for involvement– Ease of implementation and data collection– Length of involvement
Implications and Next Steps
Committed to inviting WPQC independent pharmacies to join community pharmacy network similar to WREN
– Participation voluntary in any research study
WPQC weights network more to independent pharmacy
Also important to invite chain organizations within different regions
Will build on web based interfaces & documentation
Implications and Next Steps
Particularly interested in rural and access issues so intend to visit those pharmacies
– Identify what help they want– Identify what health issues they see; share our county data– Identify extent to which health literacy is issue– Identify interest in working with MD, NP, public health
colleagues– Barriers & facilitators to roles they want/ have
Looking for opportunities related to WREN, public health, AHEC, partnerships early as well
Goals
Identify RPh-MD dyads in same county to establish a collaborative relationship
Identify issues of mutual interest to respond to their county’s priority health needs
Explore facilitators & barriers to collaboration and develop strategies to address them
Will pilot without funding and apply again (Ideas?)
Possible list of mutually beneficial topics
Training and evaluating patients in self-management (equipment, self-monitoring)
Smoking cessation Immunizations Decreasing high risk meds for elderly Health literacy Others?
Questions for you
To what extent have you worked collaboratively with a local pharmacist?– How did the relationship form?– How is it sustained?
How can a collaborative pharmacist be most helpful to you and your patients?
What would it take to form a collaborative partnership with a local pharmacist?
Other suggestions or questions?