Quality Performance in Community Pharmacies: An Exploration of Pharmacists' Perceptions and Predictors

Abstract

The improvement of healthcare quality has become an increasingly important issue in recent years. In an effort to improve quality of care, the Centers for Medicare and Medicaid Services has created a star rating system that rates insurance plans based on performance metrics. As plans attempt to improve their ratings, they have begun leaning on pharmacies to improve their performance on 5 medication utilization measures. It would be helpful to know factors associated with performance in pharmacies so that effective strategies can be designed to address these factors.

This dissertation explored the effect of leaders’ awareness, knowledge, attitude toward performance measures, offering of quality improvement-related initiatives, use of a pharmacy performance monitoring system, and leadership style on global pharmacy performance on the star rating measures.

An exploratory, mixed-methods design was utilized. Data collection and analysis was conducted in 2 major phases. In phase I, qualitative interviews with pharmacy owners of independently-owned pharmacies were conducted. Questions covered general services offered in pharmacies and awareness of the star rating measures that can be directly impacted by the pharmacist. Phase II utilized a cross-sectional study design. Data was collected from two sources: 1) a self-administered questionnaire to gather pharmacists’ knowledge, awareness and attitudes as well as offered quality improvement-related initiatives and organizational leadership and 2) pharmacy performance data from Pharmacy Quality Solutions and CECity.

Analysis of Phase I interview data led to the identification of 4 themes: 1) Awareness, 2) Attitudes, 3) Relationships, and 4) Technology. Pharmacy owners were aware of the star ratings but knowledge of measures was lacking. Those that had knowledge of star ratings reported monitoring their performance. Owners seemed to be positive about the star ratings but were skeptical that they would see any benefit from improvement in their performance. They overwhelmingly associated their high performance with their relationships with their patients and employees and they felt technology allowed for more time to spend with patients.

Analysis of Phase II questionnaire and performance data identified statistically significant relationships between knowledge of the pharmacy performance measures and the offering of quality improvement-related initiatives. It also identified attitude towards the star ratings increased the likelihood of the use of the EQuIPP platform while attitude towards the pharmacist’s role in improving the pharmacy performance scores decreased the likelihood of the use of the EQuIPP platform. This study was the first known study to investigate factors associated with pharmacy performance on the CMS adopted star rating measures. Further research is needed to identify factors that are associated with pharmacy performance.