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

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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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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?