The Role of the Pharmacist and Retail Pharmacy in Addressing the Quality Challenge in Healthcare

In the March/April issue, I spoke about utilizing the pharmacist and retail pharmacy to help address the issue of healthcare access. Let’s take a few minutes now to think about the role of the retail pharmacy in the healthcare continuum, and how this ubiquitous entity can take a more active role in addressing another one of the areas of the triple aim: quality.

Quality is not just a box that you check when you go through accreditation, but assuring appropriateness in each facet of the healthcare continuum is. There is a great deal of crossover between access and quality. Offering access to poor care or uninformed care can be as detrimental to one’s health as not having access to care at all. The Joint Commission brought focus and structure to quality within the hospital setting. The National Committee for Quality Assurance (NQCA) and the Utilization Review Accreditation Commission (URAC) brought the same type of focus and structure to health plans. Although these organizations did have some measures that focused on good pharmacy practice, they did not really address pharmacists and retail pharmacies specifically.

Enter the Pharmacy Quality Alliance (PQA). This organization was founded in 2006, coinciding with the beginning of Medicare Part D. Its mission as stated on its website is: “To improve the quality of medication management and use across healthcare settings with the goal of improving patients’ health through a collaborative process to develop and implement performance measures and recognize examples of exceptional pharmacy quality.”¹

In order to truly utilize the retail pharmacy and pharmacists as a foundational element to a healthcare solution, and to address the triple aim, I believe they need to be held accountable in terms of quality—just as providers, health plans, and hospitals are. I was a participant on a number of committees during the early years of the PQA. At that time I had my doubts that the organization could find a way to bring diverse opinions together to form something that really could achieve its goals. Thanks to Laura Cranston and a number of others, however, the PQA not only still exists but is making a difference.

In the previous issue, I also spoke about medication therapy management and the need for the healthcare consumer to have access to a pharmacist in order to best understand the medications—both prescribed and overthe- counter—they are taking. We regularly hear about overuse, underuse, and misuse of medications. More than once the Institute of Medicine has commented on the need for quality in the area of medication management. The Centers for Medicare & Medicaid Services has placed heavy emphasis on good medication management as part of its Star Rating program. My question is, why shouldn’t all healthcare consumers, not just those with Medicare coverage through a Medicare Advantage plan or a Medicare Part D plan, get quality medication management? Over 50% of us in the United States are taking chronic medications. Who better than our neighborhood pharmacists to help us understand the medications we are taking, help us remain compliant on these medications, and make sure that these medications are doing what we hope they will do?

Many employers utilize quality accreditation and other quality measures as one means of choosing the health plans they offer their employees. Is it time to do the same for pharmacists and retail pharmacies?

What do you think?