In the article by Galdo and colleagues, “Comparing Community Pharmacy Quality Ratings Scores Among Data Analytics Companies” (Inside Patient Care, October 2016), the authors say, “Often, third-party companies calculate the value of the metrics for a community pharmacy, despite the quality metrics designed by the Pharmacy Quality Alliance (PQA) for health plan assessment.” This statement is correct, although taken out of context. My following comments intend to clarify some general information.
Although the quality metrics were initially designed as a health plan assessment, they do relate to an individual pharmacy performance. This statement can be interpreted as saying these metrics should not be used for pharmacies, but they are perfectly designed for both groups. Measuring adherence at the pharmacy level is not an incorrect process, and, in fact, measuring individual patient adherence is critical for the pharmacist to know which patients need the most assistance and education about their medications. The statement is of interest because the authors proceed to compare the information of systems in the marketplace using what they indicated as not designed for pharmacy. This kind of statement may fuel those who do not want to see change, and who prefer that pharmacists not be responsible for the patients they serve.
Historically, we could have gone into any pharmacy in the United States and asked what percentage of patients using diabetes medications (or any medication) are adherent, and the pharmacy would not be able to provide any information on that. Today, pharmacies have the capability to know this, which is a move forward for our profession, and for the patients we serve.
The authors’ statement, “The results show that the measurement of quality care is dependent on the data analytics company, and that results are variable. A push toward higher-quality care in healthcare is warranted and encouraged; however, this study shows a large discrepancy in how community pharmacies are measured,” is on target with the discussion that this is very dependent on the measurement period. Without knowing whether the systems being reviewed used the same measurement period the comparison is not appropriate, unless this is mentioned as a limitation of the data. If one system was running from January through June and the other from February through July, that makes a difference in calculating adherence in terms of proportion of days covered rates. I would expect to see differences in these rates. What the authors do not mention though, is whether these groups measure all scripts, including cash, or only those through insurance plans. There is a difference here, because the financial implications are based only on claims data submitted to plans.
The conclusion of the article is accurate, with one exception—there is a standard process for measurement, as noted by the PQA. The question not addressed by the authors is why pharmacy, as a profession, is willing to leverage groups that do not use that standard and “add noise to the marketplace.” If the standard is available, the profession should support this, just as we support clinical guidelines.
The key issue missing is that regardless of what information is provided, or the method used by an analytics group, the profession has to step up and implement meaningful, patient-centered programs. Adding medication synchronization, or additional refill reminders, is not the only role that healthcare professionals should be undertaking. Rather, they should be communicating with patients who are nonadherent, to determine the reasons for nonadherence, and helping them move forward toward better health outcomes while not forgetting to continue to support patients who are adherent to therapy.
Finally, the underlying key is how do we tie adherence to actual clinical health information, such as A1c, or low-density lipoprotein. A patient who is adherent to therapy but is still not reaching clinical goals is in no better position than a patient who is nonadherent.
Thank you for the opportunity to provide some insights on this.