Quality Indicators for Pharmacy (FAQs)
(updated November 2020)
(updated November 2020)
A. Overall Scope and Purpose of the Quality Indicators for Pharmacy
To support its mandate to serve and protect the public, the College is responsible for assuring continuous quality improvement within the profession of pharmacy. Establishing quality indicators enables the College and pharmacy professionals to use data to promote a better understanding of the quality of pharmacy care and the impact pharmacy has on patient and system outcomes.
The initial focus is to provide pharmacy professionals and the public with information that will provide insight into the quality of pharmacy care and the impact of pharmacy at an aggregate level. Long-term, the College hopes to provide pharmacy professionals with information to support data-informed decision-making at the practice level.
The purpose of these indicators is to improve the quality of pharmacy care and to increase transparency about the impact of pharmacy through aggregate level public reporting. Pharmacy professionals, like other health care professionals, play an active part in providing quality and safe care to patients while contributing to solutions to address common quality challenges experienced throughout our health system. Safe transitions of care, the opioid crisis, and medication-related hospital visits are just a few examples where pharmacy can play an increasingly valuable role in our health system, while continuing to contribute directly to a patient’s health goals. However, at this time there is no way to measure pharmacy’s impact on these issues.
A strong focus on indicators already exists in other areas of the health system (for example in hospitals, primary care, long term care and home care), but community pharmacy is an area that has not historically been measured. A great deal of work has already been done to establish indicators in hospital pharmacy, including the efforts of the Canadian Society for Hospital Pharmacists. Since the primary gap is in community pharmacy, that is the current focus of the indicators work. However, it could potentially expand to other practice settings in the future.
B. The Process of Establishing the Quality Indicators for Pharmacy
A collaborative approach was used by the College to establish the quality indicators, involving community and hospital pharmacists, patients, and representatives from the Ministry of Health and Long Term Care, the Ontario Hospital Association, the Ontario Pharmacists Association, and Health Quality Ontario (now Ontario Health, Quality). The process and timeline was as follows:
Patient/Caregiver Experience and Outcomes; Provider (i.e. pharmacy professional) experience; Appropriateness of dispensed medications; Medication-related hospital visits; and, transitions of care were identified as priority areas for measurement at a stakeholder roundtable.
The expert panel comprised 16 individuals, including patients, community and hospital pharmacists, health information and measurement experts, representatives from the Ministry of Health and Long Term Care, the Ontario Hospital Association, the Ontario Pharmacists Association, HQO and the College.
A list of indicator candidates was generated for consideration.
A modified Delphi process was conducted, consisting of two surveys for independent rating of indicators and three consensus building meetings. This process was informed by extensive stakeholder (patient and sector) engagement.
Surveys of the Patient, Family and Public Advisors Network and pharmacy sector, and sessions with pharmacy professionals and corporate sector leaders were conducted.
A consensus was reached on seven quality indicators and future areas for indicator development were identified.
Due to the different requirements of the indicators established by the Expert Panel, they have been separated into three different streams of activity to facilitate data collection and reporting.
The appropriateness of dispensed medications, medication-related hospital visits, and transitions of care indicators can all be populated using existing administrative data, so these indicators are progressing as one stream of activity. Technical specifications (including indicator definitions, inclusion and exclusion criteria) for these three indicators were developed in the Fall of 2019, and these were used to begin obtaining data in 2020. The data for these indicators is now available on the College’s website here.
The patient-reported experience indicators require the collection of new data, and represent the second stream of activity. These indicators will require validation with a broad group of patients and caregivers before the development of data collection methods. The focus for 2020 is to validate these indicators so that plans for data collection and public reporting can progress in 2021.
The provider experience measurement area requires establishing new indicators as well as a plan for data collection, which represents the third stream of activity. Work with pharmacy professionals on establishing these indicators will begin in the Fall of 2020. For this stream of activity to move forward after indicators are established, data collection and reporting plans will need to be developed.
The indicators were originally established in 2019. The language used for each indicator may change due to a number of factors such as the indicator validation process, the data collection process or related technical specifications, best evidence in the literature or clinical best practices. Any changes made have been to ensure the indicators are as accurate as possible, while maintaining the original intent of the indicator. Up-to-date language is reflected on the Quality Indicators for Pharmacy webpage. More information on the version history can be found here.
C. Intended Indicator Use and Support to Implement the Indicators
These quality indicators for pharmacy are not intended to be used for quality assurance or to determine reimbursement. They are solely intended to provide the public and pharmacy sector with information about the overall quality of pharmacy care and to support the sector in gaining a better understanding of pharmacy’s impact on patient and system outcomes and drive quality improvement.
The quality indicators will be used for public reporting and for quality improvement within the sector. Pharmacist and pharmacy-specific data will not be shared publicly by the College. Only aggregate provincial and regional level data will be made public.
This initiative is not about tracking the performance of individual pharmacists, quality assurance or reimbursement. The College will report on aggregate indicator data for stakeholders to use for system-level continuous quality improvement. The College will then work with pharmacy professionals to determine which measures, data, and supports can be shared with pharmacies to support quality improvement efforts.
D. Related Initiatives
The Assurance and Improvement in Medication Safety (AIMS) Program is the College’s mandatory medication safety reporting program that has been implemented in all community pharmacies. The AIMS Program supports continuous quality improvement and puts in place a consistent standard for medication safety for all pharmacies in the province. By enabling practitioners to learn from incidents and better understand why they happen and how to prevent them, this program can reduce the risk of patient harm caused by medication incidents.
While the AIMS Program is a separate initiative to enable reporting on medication incidents and near misses to a third party for learning and improvement, both the AIMS Program and the quality indicators for pharmacy are part of the College’s efforts to promote quality improvement in pharmacy to support safe and effective patient care.
The Community Practice Environment Initiative is focused on developing principles of shared accountability through thoughtful, respectful and meaningful collaboration and engagement with pharmacy stakeholders. An Advisory Group composed of community pharmacy owners/operators, association representatives, Designated Managers, staff pharmacists and pharmacy technicians and patients/caregivers has been established to lead the development of these principles with the College.
These principles will provide a foundation for the sector to further strengthen the quality and safety of pharmacy care, and help position the profession for ongoing success as pharmacy plays an increasingly important role in the health and wellbeing of Ontarians. We anticipate that the principles of shared accountability will be shared publicly in the Fall of 2020.
While the development of provider experience measures is a separate stream of activity, the environment that pharmacy professionals practice within can affect the experience of providing care. Therefore, the development of principles of shared accountability will inform the development of provider experience measures and contribute to the College’s efforts to support safe and effective patient care.