How do we define quality in pharmacy? How do we measure pharmacy’s impact on patient outcomes? And how do we all – the regulator, pharmacy professionals, government and other stakeholders – monitor pharmacy’s impact on health system performance, make evidence-informed improvements and demonstrate the value of our collective work to patients?
This past year, the College and Health Quality Ontario (HQO), the provincial advisor on health care quality, came together to set the stage for the development of a set of standardized and system-focused indicators for pharmacy. Establishing these indicators will help answer important questions related to the quality of pharmacy practice and its impact on patient outcomes and the overall quality of our health system in the province.
As first shared with you in the Summer 2018 issue of Pharmacy Connection, the College is collaborating with Health Quality Ontario (HQO) to establish a set of quality indicators for pharmacy that will ultimately promote a culture of quality improvement within the profession of pharmacy and improve public transparency about the impact of pharmacy on patient outcomes.
Pharmacy professionals, like other healthcare professionals, play an active part in providing quality and safe care to patients while contributing to solutions to address common quality challenges experienced throughout our health system. Safe transitions of care, the opioid crisis, medication-related adverse events and antimicrobial resistance are just a few examples where pharmacy can play an increasingly valuable role in our health system, while continuing to contribute directly to a patient’s health goals. However, at this time there is no way to measure pharmacy’s impact on these issues.
The College is the regulating body for the profession of pharmacy in Ontario. As part of its duty to serve and protect the public, it is important to understand the quality of pharmacy care in Ontario, and its impact on the health system.
Developing system-focused pharmacy indicators will not only help establish pharmacy within the province’s quality health care agenda, it will promote a better understanding of the performance and impact of pharmacy on patient outcomes and on broader health system quality priorities and challenges. The adoption of a common set of indicators will lead to better data on which to make evidence-informed decisions to guide improvements in areas such as clinical practice, care models or standards and to help identify solutions that ultimately promote high-quality and safe patient care for all Ontarians.
BUILDING MOMENTUM THROUGH COLLABORATION
In June 2018, the College and HQO co-hosted a roundtable that brought together stakeholders from pharmacy, academia, health system and government agencies and patient advocates to develop a synopsis document to determine how to proceed and what areas to focus on as the indicators are developed. Following the roundtable session, the College and HQO established an expert panel to achieve consensus on a preliminary set of indicators. The panel met in early November and will continue to deliberate until the final set of indicators is selected. Patients and the pharmacy sector will remain involved in patient and sector engagement sessions to provide feedback to the panel.
The first pharmacy sector engagement session took place as an interactive webinar earlier in November where 50 participants heard about the indicator initiative and the progress to date. The College benefited greatly from the exercise which generated a positive dialogue among participants who had a number of questions about the initiative, its impact on them as professionals and how it differs from other indicator work being conducted by other organizations but for very different purposes.
Following this exercise the College is working on publishing a comprehensive FAQ resource that will be posted on the website. Until then, Pharmacy Connection has published a sampling of those FAQs here.
Q – Why are these indicators only focused on community pharmacy?
A – There has already been a lot of work done to establish indicators in hospital pharmacy, including the successful efforts of the Canadian Society for Hospital Pharmacists. The expert panel is familiar with this work and the College will align with this work wherever possible. However, for now, the primary gap is in community pharmacy and this will be the main focus of the indicators work.
Q – How do the College’s quality indicators differ from other indicators, such as those being established by insurance providers?
A – The quality indicators for pharmacy that the College is developing are not intended to be used for quality assurance or to determine reimbursement. They are solely intended to provide the public and pharmacy sector with information about the overall quality of pharmacy care and to support the sector in gaining a better understanding of pharmacy’s impact on patient outcomes. The College acknowledges that there are other indicators in development by other organizations. While it intends to learn from other such initiatives, it has no intention of overloading the sector with too many indicators and would explore potential alignment opportunities only if it aligns with the College’s goals.
Q - What will the indicators be used for? Will information be shared with the public? Will the public see how my pharmacy’s indicator performance compares to others?
A - The quality indicators will be used for quality improvement within the sector, improving broader public transparency about the impact of pharmacy practice and establishing pharmacy within the broader health system. Pharmacist and pharmacy-specific data will not be shared publicly. Only aggregate provincial/regional level data will be made public.
Q – Will the quality indicators be used to assess individual pharmacists?
A – This initiative is not about tracking the performance of individual pharmacists or for quality assurance or reimbursement. The initial function of these indicators is to leverage public reporting at a system level while striving for continuous quality improvement. Once the system level indicators are identified, efforts will be made to work with pharmacy practice to determine which measures, data, and supports can be shared with pharmacies to support quality improvement efforts.
Q - How will the indicators get chosen?
A - Roundtable participants selected indicator themes based on measurement areas where pharmacy can have an impact and where reporting on quality of pharmacy care can be done in a way that is important to patients and providers. The indicator measurement areas identified included:
- Patient/caregiver experience & outcomes
- Provider (i.e Pharmacy professional) experience
- Appropriateness of dispensed medications
- Medication-related hospital visits
- Transitions of care
The expert panel will continue to deliberate and use feedback from sector and patient engagement sessions to shortlist a set of quality indicators for pharmacy within the measurement areas identified above.