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Anna Greenberg & Nancy Lum-Wilson

New indicators major step to bringing community pharmacists into quality fold

With health care delivery in Ontario becoming more integrated, the focus on health care teams and their role in promoting and supporting positive patient outcomes is sharpening. An important member of that team is the community pharmacy professional.

Pharmacy professionals contribute to the lives of patients every day in every part of our province. Our ability to better understand the impact of pharmacy care – like other parts of the health system – on patient outcomes and health-system performance has recently been strengthened with the introduction, for the first time in Ontario, of Quality Indicators for Community Pharmacy that are linked to the system. These indicators will ultimately be used to guide and inform quality improvement across the provincial pharmacy sector.

Here, Health Quality Ontario – soon to be part of Ontario Health – Interim President and CEO Anna Greenberg and Ontario College of Pharmacists CEO and Registrar Nancy Lum-Wilson discuss the growing interest in pharmacy as a partner in integrated care and new initiatives such as introduction of quality indicators to help community pharmacists provide quality care.

Anna Greenberg: With the consolidation of agencies including Health Quality Ontario, the province is moving towards new and better models of seamless patient care. As health care professionals work more closely together it is critical that each member of the team has the right supports and feedback to fulfil their role in providing the best quality care to patients. One member of the team that sometimes operates under the radar, in part because they are not directly publicly funded, is the community-based pharmacist.

Nancy Lum-Wilson: Since the development of family health teams in Ontario, it has been recognized that pharmacists could play a key role in patient care. It has been acknowledged for some time that pharmacists could integrate their drug therapy expertise into primary care practices and help meet the challenges facing a patient population with increasingly complicated health needs. Pharmacy technicians enable this by using their technical skills to ensure the right drug is provided to the patient.

Anna Greenberg: Transitions in care between one health care setting and another have been identified by patients and providers alike as a fault line where poor communications may lead to challenges in maintaining high quality care. Research in Ontario has shown that 75% of patients with complex health and social needs are, on average, taking 13 different medications. During care transitions, the patient’s community pharmacist is often best positioned to review what drugs a patient is taking and ensure continuity of the appropriate prescriptions (and discontinuation of those that may not be appropriate).

Nancy Lum-Wilson: In addition to helping make sure patients continue to receive and take appropriate medications, recently announced changes in Ontario will expand the role of community pharmacists to allow them to prescribe medications for a number of common ailments. Surveys have repeatedly shown public support for this widening in scope which has the potential to impact hallway health care and improve access to care. However, there has historically not been a good way to measure the impact of care or for the public to understand the quality of care that community pharmacists provide. The impact of this care has been invisible and yet, with the expanded scope, the ability to measure it becomes even more important.

Anna Greenberg: Measuring the quality of care provided by health care organizations and teams is fundamental to enabling a high-performing health care system. To better understand the impact of pharmacy on the quality of patient care, Health Quality Ontario is partnering with the College, to establish the first set of quality indicators for community pharmacy in Canada. This select set of indicators (which are posted on both the College and the Health Quality Ontario websites) will provide the public with a clearer picture of the overall quality of pharmacy care, as a component of integrated care in Ontario and support quality improvement efforts by pharmacy professionals and the College. While quality indicators focused on appropriate prescribing exist in areas such as long-term care and primary care, measuring the quality of pharmacy care is relatively new territory for Ontario.

Nancy Lum-Wilson: The Ontario College of Pharmacists has a mandate to protect the public and hold Ontario’s pharmacy professionals accountable. We also have a legislated duty to promote continuing evaluation, competence and improvement of registrants and to develop establish and maintain programs and standards of practice to assure the quality of the practice of the profession. Developing indicators by which community pharmacists can assess the quality of care they provide is an important step in this process. The indicators were developed by an expert panel that included patients, practicing pharmacists, academics and other health system stakeholders. The College will continue to engage with key stakeholders such as patients, pharmacy professionals, corporate pharmacy sector leaders, academia and health system data experts as it moves forward with implementation, including developing an understanding of what tools and resources pharmacy professionals will need to support quality improvement.

The College is also reaching out to various stakeholder groups including the pharmacy sector to ensure technical specifications result in valid data being collected. The intent is to make aggregate provincial/regional (but not pharmacist or pharmacy specific) data available publicly and use system-level reports for broad continuous quality improvement.

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5 comments on article "New indicators major step to bringing community pharmacists into quality fold"

Ethel Bereznai

Hello, In regards to expanding pharmacists role, perhaps they could also be able to request lab tests that are regularly administered for certain type of conditions, such as underachieve thyroid, or high cholesterol and free up primary physicians to deal with more urgent issues. Drs and pharmacists can then receive the results and Dr can respond by making changes if necessary or pharmacist can maintain doses as previously prescribed.

Suzanne Singh

While I agree that pharmacists should be able to order certain labs, I do wonder if it is irresponsible to enable this without first prioritizing the need for pharmacists to be access labs (eg via Connecting Ontario). I do have some concerns about a potential change in scope of practice where the Ministry has asked the Ontario College of Pharmacists to look at pharmacists conducting point of care tests. There is the potential for duplicating tests, unnecessary tests, and tests that border on the controlled act of making a diagnosis.

Suzanne Singh

Pharmacists integrated in primary care teams across Ontario, including family health teams, community health centers and nurse practitioner-led clinics, provide high quality care. This is an under-recognized role for pharmacists, that ought to be funded more. Some of our work is highlighted here -

I do hope people take a moment to learn more.

Mimi Khan

Yes please continue off loading the responsibilities of the family physicians onto the pharmacists- while giving higher payment schemes to doctors.

Also remember that the College of Physicians and Surgeons is heavily promoting " safe prescribing" of more and more opioid medications to patients- while ironically, the College of pharmacists is actually urging the pharmacists to "undo this damage" by asking pharmacists to "de prescribe" opioids !!

Suzanne Singh

I am a little disappointed to read this comment. However, perhaps it speaks to real underlying concerns about advocacy efforts and remuneration strategies that reward silos, and not collaborative care. I think remuneration in particular is “the elephant in the room” when it comes to some of these issues, particularly when there is increasing pressures on everyone to do more with less.

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