More OPEN findings at OPA conference

JULY 2016 – As more findings emerge from the Ontario Pharmacy Research Collaboration (OPEN), stakeholders across the healthcare system cannot ignore the evidence of the challenges—and missed opportunities—facing pharmacists. Fortunately, the evidence also shows that pharmacists can make a positive difference for patients.

“Patient are becoming more aware and adapting to pharmacists’ new role, and they’re returning for repeat services,” Lisa Dolovich, OPEN’s co-lead researcher, announced at the Ontario Pharmacists Association’s (OPA’s) annual conference in June.

Dolovich presented a detailed summation of OPEN’s findings. The multi-stakeholder, government-funded research project, which focusses on assessing the value of pharmacists’ services that are billable to Ontario’s drug benefit plan, completed its initial three-year mandate in March this year. OPA’s conference attendees heard an overview of OPEN’s studies on immunization, MedsCheck reviews, Pharmaceutical Opinions, prescribing, deprescribing and smoking cessation. Among the highlights:

• Pharmacists are increasing the influenza immunization rate in part by attracting a new demographic: consumers aged 20 to 64 years with higher incomes (whereas physicians tend to immunize those who are younger or older, with lower incomes).
• One in nine Ontarians have received at least one MedsCheck during the first six years of the program.
• Pharmacists are less likely to conduct MedsChecks for patients taking a very high number of medications, for those older than 80 years, for women and for people with depression.
• A panel of experts across Canada identified the top five drug classes for the development of deprescribing algorithms: benzodiazepines, atypical antipsychotics, statins, antidepressants and proton pump inhibitors. Two of the algorithms are available on OPEN’s website.
• Some regions in the provinces, such as Hamilton-Niagara, had relatively much higher rates of claims for smoking cessation services. “We can learn from these regions to help improve the rate of service provision across the province,” noted Dolovich.

She also spoke to the fact that only about five percent of claims for Pharmaceutical Opinions are made within a week after the completion of a MedsCheck. “One might expect to see a connection between MedsCheck and Pharmaceutical Opinions, but it’s not happening,” Dolovich said. She later agreed with a member of the audience who suggested that the low incidence of Opinions may in part be due to the fact that physicians need to respond to pharmacists’ recommendations before the service can be billed.

The research on MedsCheck also included interviews with pharmacists and pharmacy head offices. It found that two-thirds of corporate pharmacies had targets in place, in many cases offering financial incentives to pharmacists. While both sides raised concerns over the impact on quality, Dolovich cautioned against discontinuing targets altogether. “Targets can be an important part of doing good work. We have had some missteps. Now how can we learn from that?”

OPEN, co-led by Dolovich and Nancy Waite, is continuing its work as a platform organization in three main areas: collaborative research, the communication of research findings to key stakeholders, and capacity-buildin. Its work is dependent on unrestricted funding from public and private sources. CFP’s Innovation Fund, for example, contributed $50,000 for the Pharmacists as Personalized Medicine Experts (PRIME) pilot project, which explores community pharmacists’ ability to apply genetic testing to guide the optimal use of medications. Lisa McCarthy and Beth Sproule are the research leads for PRIME. Future OPEN studies will also seek to address change management strategies, reimbursement models and integration with other healthcare professionals.