Background: Public pressure has increasingly emphasized the need to ensure the continuing quality of care\r\nprovided by health professionals over their careers. Health profession�s regulatory authorities, mandated to be\r\npublicly accountable for safe and effective care, are revising their quality assurance programs to focus on regular\r\nevaluations of practitioner performance. New methods for routine screening of performance are required and the\r\nuse of administrative data for measuring performance on quality of care indicators has been suggested as one\r\nattractive option. Preliminary studies have shown that community pharmacy claims databases contain the\r\ninformation required to operationalize quality of care indicators. The purpose of this project was to determine the\r\nfeasibility of routine use of information from these databases by regulatory authorities to screen the quality of care\r\nprovided at community pharmacies.\r\nMethods: Information from the Canadian province of Quebec�s medication insurance program provided data on\r\nprescriptions dispensed in 2002 by more than 5000 pharmacists in 1799 community pharmacies. Pharmacy-specific\r\nperformance rates were calculated on four quality of care indicators: two safety indicators (dispensing of contraindicated\r\nbenzodiazepines to seniors and dispensing of nonselective beta-blockers to patients with respiratory\r\ndisease) and two effectiveness indicators (dispensing asthma or hypertension medications to non-compliant\r\npatients). Descriptive statistics were used to summarize performance.\r\nResults: Reliable estimates of performance could be obtained for more than 90% of pharmacies. The average rate\r\nof dispensing was 4.3% (range 0 - 42.5%) for contra-indicated benzodiazepines, 15.2% (range 0 - 100%) for\r\nnonselective beta-blockers to respiratory patients, 10.7% (range 0 - 70%) for hypertension medications to\r\nnoncompliant patients, and 43.3% (0 - 91.6%) for short-acting beta-agonists in over-use situations. There were\r\nmodest correlations in performance across the four indicators. Nine pharmacies (0.5%) performed in the lowest\r\nquartile in all four of the indicators, and 5.3% (n = 95) performed in the lowest quartile on three of four indicators.\r\nConclusions: Routinely collected pharmacy claims data can be used to monitor indicators of the quality of care\r\nprovided in community pharmacies, and may be useful in future to identify underperforming pharmacists, measure\r\nthe impact of policy changes and determine predictors of best practices.
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