Development of Quality Indicators to Assess Oral Anticoagulant Management in Community Pharmacies for Patients with Atrial Fibrillation

Abstract

This research was supported by the Réseau Québécois de recherche sur le médicament (RQRM); the Blueprint for Pharmacy in collaboration with Pfizer Canada; and the Cercle du Doyen of the Faculty of Pharmacy, University of Montreal. The study sponsors were not involved in the study design, data collection, data interpretation, the writing of the article, or the decision to submit the report for publication. Chartrand received a scholarship from the Fonds de Recherche du Québec en Santé (FRQ-S), the Réseau Québécois de recherche sur l'usage des médicaments with Pfizer, and the Faculty of Pharmacy, University of Montreal. Guénette holds a Junior-1 Clinician Researcher Award from the FRQ-S in partnership with the Société québécoise d'hypertension artérielle. Williamson holds a Junior-1 Career Award from the FRQ-S. Côté reported being a medical speaker for Bayer, Boehringer Ingelheim Canada, and Pfizer Canada. The other authors reported no conflicts of interest. Study concept and design were contributed by Lalonde, Chartrand, and Martin. Chartrand, Martin, and Lalonde collected the data, along with Brouillette, Côté, Huot, Landry, Martineau, Perreault, Williamson, and White-Guay. Data interpretation was performed by Chartrand, Gagnon, and Lalonde, along with Guénette and Martin. The manuscript was primarily written by Chartrand, along with Guénette and Lalonde, and revised by Chartrand, Guénette, and Lalonde, along with the other authors. A portion of this study's results was presented at the 4th RQRM Annual Meeting on September 22-23, 2014, in Orford, Quebec, Canada, in the form of an abstract, which was published in the Journal of Population Therapeutics and Clinical Pharmacology, 2014;21(2):e312.

Anticoagulation management services in community pharmacy: Feasibility of implementing a quality improvement programme through a practice-based research network

“…Furthermore, although PBRNs are frequently used by primary care physicians to conduct research, they are less commonly used by community pharmacists. The ACO programme was based on QIs developed by experts using a rigorous approach (the modified RAND/UCLA appropriateness method) that ensured thorough evaluation of quality and covered many aspects of therapy management . We limited restrictions for patient inclusion in the ACO programme to enhance external validity.…”

“…Also, some QIs were applicable to only a small proportion of patients. It could be useful to validate QIs further with regard to predictive validity (eg, clinical outcomes) . Moreover, the knowledge questionnaire has never been validated.…”

“…Quality indicators were evaluated by the research team using questionnaire information completed by participants at T0 and T6 for each identified patient. The questionnaire included 17 multiple‐choice or short answer questions for VKA patients and 12 for DOAC patients . Participants were instructed to consider all interventions documented in the patient's pharmacy record over the past 6 months, as well as the initial physician's prescription, including clinical information (eg, INR target and diagnosis).…”

“…The questionnaire included 17 multiplechoice or short answer questions for VKA patients and 12 for DOAC patients. 27 Participants were instructed to consider all interventions documented in the patient's pharmacy record over the past 6 months, as well as the initial physician's prescription, including clinical information (eg, INR target and diagnosis). The QIs are described in detail elsewhere (Appendix S2).…”

“…The ACO programme was based on QIs developed by experts using a rigorous approach (the modified RAND/ UCLA appropriateness method) that ensured thorough evaluation of quality and covered many aspects of therapy management. 27 in accordance with the inclusion criteria, there was no mechanism in place to ensure this was done correctly. Finally, the quality of clinical practices was self-reported via questionnaire, an approach that is susceptible to reporting bias.…”