Led by Linda MacKeigan at the University of Toronto and Lisa Dolovich at McMaster University, this project is evaluating the quality and impact of Ontario’s MedsCheck Annual, MedsCheck Diabetes and Pharmaceutical Opinion Programs — medication review and physician consultation services provided by community pharmacists and reimbursed by the Ontario Public Drug Programs, beginning in 2007 with MedsCheck Annuals.
The research team is also investigating whether these medication management services are reaching the patients most likely to benefit from them as well as what influences their uptake by community pharmacies.
The first phase of research is well underway using linked healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences to describe the recipients of MedsCheck Annual and Pharmaceutical Opinion services.
OPEN has been collaborating with THETA — the Toronto Health Economics and Technology Assessment group — on the analysis of MedsCheck Annual services.
“Preliminary descriptive results have revealed that almost 1.5 million Ontarians — 55% of which were seniors and 55% were women — had received a MedsCheck Annual assessment from a pharmacist in the six years between 2007 and 2013,” Dr. Dolovich said.
“We see that service provision increased over time, with a sharper increase after 2010. Ten percent of recipients had experienced a hospitalization or emergency department visit in the month before they had a MedsCheck Annual assessment.”
Further results from this analysis will be presented in November 2014 at the Canadian Association for Population Therapeutics conference.
“We have also conducted 22 of an expected 50 interviews with key informants — interviews with corporate pharmacy executives, independent pharmacy owners, pharmacy managers and policy makers,” Dr. MacKeigan said.
“These interviews will be analyzed qualitatively to identify themes related to implementation strategies and challenges, perceived quality of service, innovative service models and suggestions for program improvement. These findings will help to interpret the results of our earlier quantitative analysis of MedsCheck claims and linked administrative data.”
An audit of MedsCheck Annual, MedsCheck Diabetes and Pharmaceutical Opinion records in 35 community pharmacies, representing a range of ownership types, prescription volumes and regions of Ontario, is about to get underway. Its purpose is to determine the typical enquiries made during a MedsCheck as well as the potential impact of MedsCheck and Pharmaceutical Opinion services, as illustrated by the drug-related problems identified and actions taken.
This audit was informed by a pilot audit — conducted by a PharmD student working on the project — of a sample of MedsCheck Annual and Diabetes records at four pharmacies in the Toronto area.
“Our pharmacy student’s pilot audit revealed that the mandatory components of a medication list were usually documented, except for medication indication, which was documented in 60% of the forms,” Dr. MacKeigan said.
Pharmacist inquiries about disease monitoring were documented for 61% of patients with hypertension, hyperlipidemia or diabetes, but the parameter values were noted in only 31% of the forms. Pharmacist recommendations were documented on 56% of forms.
“Most recommendations pertained to adherence, medication administration or side effects, but information about the drug-related problem addressed was insufficient to assess the clinical significance of the recommendation,” Dr. MacKeigan said.
“The remaining components of this project include a patient survey, pharmacist survey, physician interviews and best practice case studies.”