Betty Chewning, PhD, Director Michelle Chui, PharmD, PhD Sonderegger Research Center UW School of Pharmacy

1. Development of a Wisconsin Pharmacy Practice-based Research Network, using the WREN Model - Potential Research Collaboration with Both Networks Betty Chewning, PhD, Director Michelle Chui, PharmD, PhD Sonderegger Research Center UW School of Pharmacy

2. SRC Research History • First academic research center on social and administrative pharmacy internationally (1985) • Primarily NIH, AHRQ, FDA funded research • Patient provider decision making/ patient centered care; drug use behavior; public health (tobacco/ BP); caretaker needs; quality of care; pharmacy ESL needs, workforce, finance, policy

3. WI Population increased 15% (1990-2008)

4. # of Pharmacies decreased 6.2% Persons / Pharmacy increased 22% Mott, Jenders, 2008

5. County Summary (1990-2008) • 66 of 72 WI counties increased population • 49 increased 10% or more • 36 counties decreased number of community pharmacies • 20 of those 36 had a decrease of 20% or more • 31 increased population & decreased community pharmacies • Only Rusk County decreased population & increased pharmacy

6. What does it mean? • Rural pharmacies are key access point of care for medication users, but busy • Example: the average pharmacy in Bayfield county went from filling an average of 142 prescriptions per day in 1990 to 460 prescriptions per day in 2008

7. Challenge Now • Identify barriers & facilitators to help busy pharmacists meet health needs more effectively • Quality, efficiency, provider and patient expectations • Identify potential partnerships with clinicians, public health groups, patients • Match health needs of counties with expertise and access point of pharmacists

8. State Funded Pharmacy Group Intervention For Tobacco Cessation • RCT of 16 Walgreens pharmacies (30 pharmacists) trained to refer to Tobacco Quit Line, funded by state of WI (Patwardhan, Chewning) • Invaluable Lessons Learned that: • We can work with a group of chain pharmacies • How to prepare sites, develop documentation tools • Chain pharmacies can aid communication, motivate tech and RPh participation & standardize research protocols • Found could train RPh & techs in Walgreens to expand roles, document intervention consistently, increase referrals to Quit Line, complete data collection (100% pre-post surveys back)

9. Wisconsin Pharmacy Quality Collaborative (WPQC) • Collaborative between payors and pharmacies called together by the Pharmacy Society of Wisconsin (PSW) • Why? Well over 50% of all Rx orders are not used as intended or prescribed • Goal is to establish a uniform set of pharmacist-provided medication therapy management services and a quality credentialing process • Characteristics of Program • Quality credentialing • Level I professional services (one-time, point of service) • Level II professional services (Med therapy management) • Technology platform through McKesson • Standardization of requirements, documentation and billing

10. WPQC Project Status • 54 pharmacies (120 pharmacists) enrolled in study • 70,000 lives with current insurers (Central, SE WI) • Waiting on two additional major insurers • Pharmacies must meet 12 “best practice” requirements to participate in network • Open and show each medication to patient • Continuous Quality Improvement Program • Verifying patient weights for all pediatric meds • Can offer intervention-based services or comprehensive medication review and assessment services

11. Evaluation of WPQC (Mott PI) • SRC joined with PSW and insurers • Goal: To evaluate impact of reimbursing pharmacies to do comprehensive medication review (level 2) & level 1 services (point-of-care) with patients • Began baseline data collection on RPh self-efficacy; perceived barriers & facilitators • Qualitative analysis of workflow and work system changes • Developing web based surveys with pharmacists willing to do web rather than mail

12. Data From Claims • Pharmacy level reports • Pharmacy level reports can create various comparisons within WPQC pharmacies as well as with other Wisconsin pharmacies. Data will be aggregated for health plan • Selected pharmacies will be given patient-level reports

13. Pharmacy Quality Alliance (PQA) • Commissioned by CMS • National group working with National Clearinghouse on Quality Assessment (NCQA) and National Quality Forum • 5 Funded Demonstration sites • Wisconsin WPQC project sites, Purdue, North Carolina, Rite Aid-Pennsylvania • Testing the feasibility of utilizing PQA clinical quality measures for quality credentialing • Management of specific chronic measures (treatment of ACE-I in diabetic patients, use of high risk meds in elderly)

14. Pharmacy Quality Alliance (PQA) WPQC Project and SRC will help PQA to examine: • Ability to calculate QI’s from claims data • Ability to develop a web-based system to educate pharmacists on performance measurement/ quality • How well community pharmacists can use web system to understand and take action on QI’s potentially

15. Why Do We Need A Pharmacy Research Collaborative Network? • Unmet health needs particularly in counties with access issues • Wisconsin has 1200 community pharmacies and 5,000 pharmacists often underused • 1st Question is how pharmacy can best help meet health needs of a county • 2nd Question is how can pharmacists expand roles to fit with their economic pressures

16. Building Foundation for Network • Gathering advice from colleagues • Using existing data to identify how pharmacy can best respond to county needs • County health needs, resource profile • County location of community pharmacies • Income, minority profile • Seeking funding through collaborative research and infrastructure support

17. Implications and Next Steps • Successful research partnerships with groups of pharmacies is possible with both chain and independent pharmacies • Different groups of pharmacies seem drawn to different types of projects depending on: • Research goals • Criteria for involvement • Ease of implementation and data collection • Length of involvement

18. Implications and Next Steps • Committed to inviting WPQC independent pharmacies to join community pharmacy network similar to WREN • Participation voluntary in any research study • WPQC weights network more to independent pharmacy • Also important to invite chain organizations within different regions • Will build on web based interfaces & documentation

19. Implications and Next Steps • Particularly interested in rural and access issues so intend to visit those pharmacies • Identify what help they want • Identify what health issues they see; share our county data • Identify extent to which health literacy is issue • Identify interest in working with MD, NP, public health colleagues • Barriers & facilitators to roles they want/ have • Looking for opportunities related to WREN, public health, AHEC, partnerships early as well

20. Goals • Identify RPh-MD dyads in same county to establish a collaborative relationship • Identify issues of mutual interest to respond to their county’s priority health needs • Explore facilitators & barriers to collaboration and develop strategies to address them • Will pilot without funding and apply again (Ideas?)

21. Possible list of mutually beneficial topics • Training and evaluating patients in self-management (equipment, self-monitoring) • Smoking cessation • Immunizations • Decreasing high risk meds for elderly • Health literacy • Others?

22. Questions for you • To what extent have you worked collaboratively with a local pharmacist? • How did the relationship form? • How is it sustained? • How can a collaborative pharmacist be most helpful to you and your patients? • What would it take to form a collaborative partnership with a local pharmacist?

23. Other suggestions or questions?