Impacts on practice
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A validated set of indicators is useful to measure pharmaceutical care in community pharmacies.
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A set of practice indicators is best compiled in cooperation with pharmacists and external stakeholders e.g. healthcare inspectorate, patient organizations and health insurers.
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Measurement of indicators in pharmacy practice and feedback of indicator scores results in overall score improvement.
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Further research is needed to better understand and facilitate quality improvement in individual pharmacies.
Introduction
Aim of the study
Ethics approval
Methods
Study design
Setting for data collection
Quality indicator survey tool
Concurrent source of dispensing outcomes for quality indicator score validation
Data analysis
Results
Mean full time equivalent (38-h working week) pharmacists employed per pharmacy (5th and 95th percentile) | 1.36 (0.8; 2.4) |
Mean full time equivalents (36-h working week) pharmacy technicians employed per pharmacy (5th and 95th percentile) | 6.37 (2; 12) |
Percentage of community pharmacies with a separate room available for counselling | 96.4 |
Percentage of community pharmacies that supply nursing homes | 31.1 |
Percentage of community pharmacies that participate in night and weekend services | 99.2 |
Percentage of community pharmacies that cooperate with other pharmacists and healthcare providers for pharmaceutical care in a structured way | 70.2 |
Percentage of community pharmacies that compound medicines within the pharmacy | 30.9 |
Percentage of community pharmacies that supply of compounded medications to more than one other pharmacy | 4.1 |
Scorea
| Type | |
---|---|---|
1. Quality management | ||
1.1 Presence of a valid quality management certificateb
| 84.4 | S |
1.2 Evaluating patients’ experiences within the past 3 yearsb
| 93.9 | S |
1.3.1 Availability of a procedure for registration of errors (e.g. wrong dosage, wrong substance, wrong compounding) that occurred during the work process in the pharmacy and that were realized before the drug reached the patientb
| 73.2 | S |
1.3.2 Number of registered errors which occurred during the dispensing of medication and that occurred during the work process in the pharmacy and that were realized after the drug reached the patientc
| 42.2 (0; 205) | P |
1.4 Presence of a registration system for errors that occurred during the work process within the pharmacy and that did reach the patientb
| 98.8 | S |
1.5 Number of registered errors that did reach the patientc
| 18.0 (0; 64) | P |
1.6 Number of registered complaints made by patientsc
| 29.1 (0; 150) | P |
1.7 Number of registered errors reported to a national registration of errorsc
| 1.5 (0; 3) | P |
2. Continuity of care | ||
2.1 Attitude of the pharmacist to obtain information on patients’ actual drug use before dispensing and to register this information in the patients’ recordb
| 95.0 | S |
2.2.1 Participation in pharmacotherapy audit meetings with general practitioners (GPs)b
| 98.7 | S |
2.2.2 Participation in pharmacotherapy audit meetings on a regular basis and with specific agreementsb
| 84.6 | S |
2.3 Percentage of patients older than 70 years with at least 5 different drug classes in chronic concomitant use, for whom the pharmacist contributed to the exchange of actual drug use information between the general practitioner and the hospitalc
| 54.7 (0; 100) | P |
2.4 The pharmacy staff always informs the anticoagulation directly in case of dispensing co-trimoxazole to a coumarin userb
| 99.5 | S |
3. Communication with the patient | ||
3.1 Percentage of patients with a first dispensing of inhalation medication who had been offered information about its usec
| 70.0 (4; 100) | P |
3.2 Percentage of users of inhalation medication with subsequent use of oropharyngeal antimycoticsc
| 1.48 (0.5; 16) | O |
3.3 Presence of individual education programs and plans for every pharmaceutical staff memberb
| 94.6 | S |
4. Clinical risk management | ||
4.1 Parameters for clinical risk management in the pharmacy information system are implemented according to prevailing guidelinesb
| 98.8 | S |
4.2 In case of an interaction actions taken are electronically registered | 97.9 | S |
4.3 Availability of protocols for informing on contra indications for all patients, especially for new patientsb
| 98.6 | S |
4.4 Availability of protocols for informing on allergic reactions for all patients, especially for new patientsb
| 98.9 | S |
4.5 Availability of protocols to check on the dosage of active components for compounded medication for children up to 6 yearsb
| 97.5 | S |
4.6 Dosage in compounded mediation for children up to 6 years is checked by the pharmacist in at least 80 % of all compounding for children younger than 6 yearsb
| 83.9 | P |
4.7 Absolute number of coumarin users with concomitant use of co-trimoxazolec
| 0.69 (0; 2) | O |
5. Compounding | ||
5.1 Availability of written agreements on responsibilities for external compounding on checking the weight of capsules, analytical tests of samples and a final control by a pharmacistb
| 96.5 | S |
5.2 Availability of a standard operation procedure for the release of compounded medication before dispensing to the patientb
| 98.8 | S |
5.3.1 Percentage of medication compounded for individual patients for which a standardized procedure was followedc
| 75.4 (6; 100) | P |
5.3 2 Percentage of compounding of batches with a validated procedure followed of all batch compoundingc
| 87.9 (16; 100) | P |
6. Dispensing | ||
6.1.1 Availability of automated dose dispensing for eligible patientsb
| 92.0 | S |
6.1.2 If automated dose dispensing was used the actual guideline was followed by as well the pharmacist as the supplierb
| 98.9 | S |
6.2 For weekly dosed trays a system was available to control on drug use as prescribed | 97.5 | S |
7. Follow up of pharmacotherapy guidelines | ||
7.1.1 Percentage NSAID users >70 years with concomitant gastroprotectionc
| 84.7 (70; 96) | O |
7.1.2 Action was taken by the pharmacist in at least 80 % of the cases to add gastroprotection to NSAID users >70 years for whom this co-medication was lackingb
| 32.3 | P |
7.2.1 Percentage of patients using nitrates with concomitant antithrombotic medicationc
| 93.0 (86; 100) | O |
7.2. Action was taken by the pharmacist in at least 80 % of the cases to add antithrombotic medication to nitrate users for whom this co-medication was lackingb
| 18.0 | P |
7.3.1 Percentage of patients using opioids with concomitant laxativesc
| 54.1 (35; 76) | O |
7.3.2 Action was taken by the pharmacist in at least 80 % of the cases to add laxatives to opioid users in whom this co-medication was lackingb
| 14.3 | P |
7.4 Percentage of patients under 6 or above 70 years of age with asthma inhalers and an additional inhalation device dispensed during the previous 24 monthsc
| 69.0 (49; 86) | O |
7.5 Percentage of simvastatin as the first statin dispensedc
| 67.0 (34; 93) | O |
7.6 Percentage of cardiovascular patients with concomitant statin usec
| 75.7 (68; 83) | O |
7.7 Percentage of triptan users without overuse within all triptan usersc
| 93.3 (87; 99) | O |
7.8 Percentage of first dispensings of hypnotics with an amount for less than 15 days within all first hypnotic dispensingsc
| 69.9 (47; 91) | O |
7.9 Percentage of proton pump inhibitor (PPI) users with preferred PPIs according to national guidelines within all PPI usersc
| 82.2 (71; 91) | O |
7.10 Percentage of first dispensings of generic diclofenac, ibuprofen or naproxen within all first NSAID dispensingsc
| 84.7 (67; 96) | O |
7.11 Percentage of COXib users without co-medication related to ischemic cardiovascular diseases within all COXib usersc
| 83.4 (73; 94) | O |
7.12.1 The pharmacist followed additional courses for the performance of Medication Reviewsb
| 73.8 | P |
7.12.2 Medication Reviews are performed according to the professional guideline in cooperation with GPs and patientsb
| 92.6 | S |
7.12.3 Performance of at least 20 Medication Reviews according to the professional guideline in cooperation with GPs and patientsb
| 57.3 | P |
8. OTC counseling | ||
8.1 Medication surveillance is conducted according to professional protocolsb
| 99.6 | S |
8.2.1 Percentage of filled protocols for patient counseling within first dispensing of orlistatc
| 76.9 (0; 100) | P |
8.2.2 Percentage of filled protocols for patient counseling within first dispensing of dextromethorphanc
| 66.9 (0; 100) | P |
8.2.3 Percentage of filled protocols for patient counseling within first dispensing of hypericumc
| 64.6 (0; 100) | P |
8.2.4 Percentage of filled protocols for patient counseling within first dispensing of domperidonc
| 70.5 (0; 100) | P |
8.2.5 Percentage of filled protocols for patient counseling within first dispensing of hydrokininc
| 67.5 (0; 100) | P |
9. Logistics | ||
9.1 Suppliers of compounding material were assessed according to the professional guidelineb
| 99.4 | S |
9.2 Percentage of suppliers for compounding or package material that were assessed for their reliability as stated by the guideline for reliable supplier sc
| 74.6 (13;100) | S |
9.3 Availability of a valid system to check on expired drugsb
| 99.7 | S |
9.4 Official drug recalls were performedb
| 99.8 | S |
9.5.1 Number of relevant recalls received in calendar in questionc
| 8.0 (0;15) | P |
9.5.2 Number of not completely finished recallsc
| 0.9 (0; 8) | P |
9.5.3 Not completed drug recalls were due to a too high effort to address patientsb
| 3.7 | P |
9.6.1 Number of internally reported expired medication before the drug was dispensedc
| 1.8 (0; 7) | P |
9.6.2 Number of dispensed expired medication that was reported by the patient and thus was noticed after dispensingc
| 1.8 (0; 2) | P |
10. Training of pharmaceutical staff | ||
10.1.1 Percentage of pharmaceutical staff with a personal development planc
| 60.0 (0; 100) | S |
10.1.2 Percentage of pharmacy technicians who were registered in a central quality registration system for educationc
| 33.4 (0; 100) | S |
10.2 Participation in a national program for patient reported side effects drugs of the national pharmacovigilance centerb
| 87.5 | S |
10.3 Number of patient reported side effects announced to the national pharmacovigilance centerc
| 1.4 (0; 5) | P |
10.4 Percentage of employees involved in pharmaceutical care that followed an education in communication skillsc
| 32.2 (0; 100) | S |
Type | 2008 | 2009 | 2010 | 2011 | 2012 | ICCa
| |
---|---|---|---|---|---|---|---|
Categorical quality indicators (percentage of community pharmacies with a positive answer within all given answers)
| |||||||
1.1 Presence of a valid quality management certificate | S |
63.3
|
67.6
|
75.2
|
83.0
|
84.4
|
0.90
|
1.2 Evaluation of patients’ experiences within the past three years | S |
86.7
|
81.6
|
84.4
|
92.8
|
93.9
|
0.48
|
2.2.2 Participation in pharmacotherapy audit meetings on a regular basis and with specific agreements | S |
77.7
|
78.8
|
80.6
|
86.2
|
84.6
|
0.18
|
4.3 Availability of protocols for informing on contra indications for all patients, especially new ones | S | 74.3 | 89.7 | 91.5 | 96.3 | 98.6 | 0.89 |
7.12.3 Medication Reviews are performed according to the professional guideline in cooperation with GPs and patients | S |
20.3
|
26.3
|
39.6
|
50.3
|
57.3
|
0.14
|
Numerical quality indicators (mean of numbers of percentages)
| |||||||
3.1 Percentage of patients with a first dispensing of inhalation medication who had been offered information about its use | P | 57.9 | 68.5 | 72.9 | 67.4 | 70.0 | 0.45 |
4.7 Absolute number of coumarin users with concomitant use of co-trimoxazole | O | 18.2 | 1.12 | 0.75 | 0.71 | 0.69 | 0.01 |
7.1.1 Percentage NSAID users >70 years with concomitant gastro protection | O | 70.8 | 76.8 | 81.8 | 84.0 | 84.7 | 0.54 |
7.2.1 Percentage of patients using nitrates with concomitant antithrombotic medication | O | 75.8 | 84.9 | 90.9 | 92.0 | 93.0 | 0.46 |
7.3.1 Percentage of patients using opioids with concomitant laxatives | O | 44.5 | 52.6 | 52.8 | 56.1 | 54.1 | 0.51 |