An Innovative Approach to Improving the Proposed CMS Star Rating "Statin Use in Persons with Diabetes".

The Statin Use in Persons with Diabetes (SUPD) measure has been adopted by the Centers for Medicare and Medicaid Services as a display measure for Medicare Part C and Part D plan sponsors and is slated for inclusion within the primary star rating measure set. As such, the measure has become a focal point for quality improvement efforts by many health plans. Current pharmacy-based interventions reported in the literature involve pharmacists recommending that a patient's provider issue a prescription for a statin; studies to date have not shown that this intervention has been effective for the majority of patients with diabetes. One innovative option is pharmacist prescriptive authority of statins for patients with diabetes. In such a model, a pharmacist identifies a patient with diabetes who is not on a statin, assesses the patient for contraindications and appropriateness of therapy, and works directly with the patient to close the gap in care. This solution could lead to earlier initiation of statin therapy and reduce the burdens associated with multiple communications with the patient's primary care provider. In 2018, Idaho became the first state to allow pharmacist prescribing to close the SUPD measure, with certain regulatory safeguards in place. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.

Pharmacist-to-prescriber intervention to close therapeutic gaps for statin use in patients with diabetes: A randomized controlled trial.

OBJECTIVE: To assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy. DESIGN: The Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication. SETTING: This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard. PARTICIPANTS: In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy. INTERVENTION: The control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type. RESULTS: The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was "Patient has normal cholesterol" and this caused the greatest amount of discussion between pharmacist and prescriber. CONCLUSION: Through a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care.

An Analysis of Quality Improvement Education at US Colleges of Pharmacy.

Objective. Analyze quality improvement (QI) education across US pharmacy programs. Methods. This was a two stage cross-sectional study that inspected each accredited school website for published QI curriculum or related content, and e-mailed a questionnaire to each school asking about QI curriculum or content. T-test and chi square were used for analysis with an alpha a priori set at .05. Results. Sixty responses (47% response rate) revealed the least-covered QI topics: quality dashboards /sentinel systems (30%); six-sigma or other QI methodologies (45%); safety and quality measures (57%); Medicare Star measures and payment incentives (58%); and how to implement changes to improve quality (60%). More private institutions covered Adverse Drug Events than public institutions and required a dedicated QI class; however, required QI projects were more often reported by public institutions. Conclusion. Despite the need for pharmacists to understand QI, it is not covered well in school curricula.

Defining and Measuring Primary Medication Nonadherence: Development of a Quality Measure.

Poor medication adherence has been increasingly recognized as a major public health issue and a priority for health care reform. Primary medication nonadherence (PMN) is a subset of this broader subject and occurs when a new medication is prescribed for a patient, but the patient does not obtain the medication, or an appropriate alternative, within an acceptable period of time after it was prescribed. It is increasingly evident that the public health problem of PMN is widespread. However, the lack of standardized definitions and measures inhibits the ability to establish the true incidence of this problem or to track changes in PMN rates over time. Given the limitations of current measures, the Pharmacy Quality Alliance (PQA) convened an expert working group to set parameters for a new industry measure. That new measure, which links electronic prescribing and pharmacy dispensing databases and was developed and approved by the PQA, is described here. PMN literature from 1990 to June 2015 is also reviewed, and existing PMN measures are summarized. DISCLOSURES: No funding was received for this article, and the authors declare no conflicts of interest. The views expressed in this article are those of the authors alone and do not necessarily reflect those of their respective employers. Adams has received grant support from Pfizer for adherence research. Adams and Stolpe were equally involved in all aspects of study design, data collection and interpretation, and manuscript preparation.

Prevalence, effectiveness, and characteristics of pharmacy-based medication synchronization programs.

OBJECTIVES: The burden of visiting pharmacies to fill medications is a central contributor to nonadherence to maintenance medications. Recently, pharmacies have begun offering services that align prescription fill dates to allow patients to pick up all medications on a single visit. We evaluated the prevalence and structure of synchronization programs and evidence of their impact on adherence and clinical outcomes. STUDY DESIGN: Mixed-methods approach consisting of semi-structured interviews, data from surveillance activities, and a systematic literature review. METHODS: We conducted interviews with opinion leaders from nonprofit advocacy organizations and exemplary synchronization programs. Program prevalence was determined using data from regular surveillance efforts. A literature review included Medline, EMBASE, Google Scholar, and general Internet searches. RESULTS: Synchronization programs exist in approximately 10% of independent, 6% of stand-alone chain, and 11% of retail store pharmacies. The majority of programs include a monthly pharmacist appointment and reminder communication. Programs reported the importance of pharmacist buy-in, technology to track and recruit patients, links to other healthcare services, and flexible solutions for managing costs and communication preferences. Although existing peer-reviewed literature suggests that synchronization improves adherence, more evidence is needed to evaluate its impact on patient-centered outcomes. CONCLUSIONS: As medication synchronization programs shift directions and compete for patients and payer resources, it will be more important than ever to rigorously evaluate their ability to improve clinical outcomes while also providing the growing number of patients managing multiple chronic conditions with the highest level of patient engagement and consumer choice.

Student pharmacists' perceptions of community pharmacy residency programs.

OBJECTIVES: To compare penultimate-year (next-to-last) and final-year student pharmacists' perceptions of the educational value of community pharmacy residency programs (CPRPs) and to compare student pharmacists' perceptions of the educational value of CPRPs and health-system residency programs (HSRPs). METHODS: A self-administered online survey was sent to administrators at 119 Accreditation Council for Pharmacy Education-accredited schools of pharmacy for ultimate distribution to penultimate- and final-year student pharmacists. The survey included demographic measures and a 20-item residency program "perceived value of skill development" scale developed for this study. RESULTS: 1,722 completed surveys were received and analyzed. Penultimate-year students attributed greater value to CPRPs more frequently than final-year students. Students more often attributed higher value to CPRPs for skills related to business management, practice management, and medication therapy management, while they attributed higher value to HSRPs for skills related to teaching, research, and clinical knowledge. CONCLUSION: The results of this study suggest students' perceived value of CPRPs may be related to their year of pharmacy school and the pharmacy practice skill in question.

Historical development and emerging trends of community pharmacy residencies.

Clinical pharmacy services necessitate appropriately trained pharmacists. Postgraduate year one (PGY1) community pharmacy residency programs (CPRPs) provide advanced training for pharmacists to provide multiple patient care services in the community setting. These programs provide an avenue to translate innovative ideas and services into clinical practice. In this paper, we describe the history and current status of PGY1 community pharmacy residency programs, including an analysis of the typical settings and services offered. Specific information on the trends of community programs compared with other PGY1 pharmacy residencies is also discussed. The information presented in this paper is intended to encourage discussion regarding the need for increasing the capacity of PGY1 community pharmacy residency programs.

"Tech-check-tech": a review of the evidence on its safety and benefits.

OBJECTIVE: The published evidence on state-authorized programs permitting final verification of medication orders by pharmacy technicians, including the programs' impact on pharmacist work hours and clinical activities, is reviewed. SUMMARY: Some form of "tech-check-tech" (TCT)--the checking of a technician's order-filling accuracy by another technician rather than a pharmacist--is authorized for use by pharmacies in at least nine states. The results of 11 studies published since 1978 indicate that technicians' accuracy in performing final dispensing checks is very comparable to pharmacists' accuracy (mean ± S.D., 99.6% ± 0.55% versus 99.3% ± 0.68%, respectively). In 6 of those studies, significant differences in accuracy or error detection rates favoring TCT were reported (p < 0.05), although published TCT studies to date have had important limitations. In states with active or pilot TCT programs, pharmacists surveyed have reported that the practice has yielded time savings (estimates range from 10 hours per month to 1 hour per day), enabling them to spend more time providing clinical services. States permitting TCT programs require technicians to complete special training before assuming TCT duties, which are generally limited to restocking automated dispensing machines and filling unit dose batches of refills in hospitals and other institutional settings. CONCLUSION: The published evidence demonstrates that pharmacy technicians can perform as accurately as pharmacists, perhaps more accurately, in the final verification of unit dose orders in institutional settings. Current TCT programs have fairly consistent elements, including the limitation of TCT to institutional settings, advanced education and training requirements for pharmacy technicians, and ongoing quality assurance.