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
SRC Research History
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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
WI Population increased 15%
(1990-2008)
WI Population from 1990-2008
Number of people
5,800,000
5,600,000
5,400,000
5,200,000
5,000,000
4,800,000
4,600,000
4,400,000
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20
Years since 1990
# of Pharmacies decreased 6.2%
Persons / Pharmacy increased 22%
WI Community Pharmacies from 1990-2008
Number of Community
Pharmacies
1080
1060
1040
1020
1000
980
960
1
2
3
4
5
6
Years
Mott, Jenders, 2008
7
8
9
10
County Summary (1990-2008)
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66 of 72 WI counties increased population
–
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36 counties decreased number of community
pharmacies
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49 increased 10% or more
20 of those 36 had a decrease of 20% or more
31 increased population & decreased community
pharmacies
Only Rusk County decreased population & increased
pharmacy
What does it mean?
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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
Challenge Now

Identify barriers & facilitators to help busy
pharmacists meet health needs more
effectively
–
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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
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:
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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)
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
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Quality credentialing
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Level I professional services (one-time, point of service)
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Level II professional services (Med therapy management)
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Technology platform through McKesson
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Standardization of requirements, documentation and billing
WPQC Project Status

54 pharmacies (120 pharmacists) enrolled in study
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Pharmacies must meet 12 “best practice”
requirements to participate in network
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70,000 lives with current insurers (Central, SE WI)
Waiting on two additional major insurers
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
Evaluation of WPQC (Mott PI)
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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
Data From Claims
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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 patientlevel reports
Pharmacy Quality Alliance (PQA)
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Commissioned by CMS
National group working with National Clearinghouse
on Quality Assessment (NCQA) and National Quality
Forum
5 Funded Demonstration sites
–
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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)
Pharmacy Quality Alliance (PQA)
WPQC Project and SRC will help PQA to
examine:
–
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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
Why Do We Need A Pharmacy
Research Collaborative Network?

Unmet health needs particularly in counties
with access issues
–
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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
Building Foundation for Network
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Gathering advice from colleagues
Using existing data to identify how pharmacy
can best respond to county needs
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County health needs, resource profile
County location of community pharmacies
Income, minority profile
Seeking funding through collaborative
research and infrastructure support
Implications and Next Steps
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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:
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–
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Research goals
Criteria for involvement
Ease of implementation and data collection
Length of involvement
Implications and Next Steps

Committed to inviting WPQC independent
pharmacies to join community pharmacy network
similar to WREN
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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
Implications and Next Steps

Particularly interested in rural and access issues so
intend to visit those pharmacies
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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
Goals
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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?)
Possible list of mutually beneficial
topics
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Training and evaluating patients in selfmanagement (equipment, self-monitoring)
Smoking cessation
Immunizations
Decreasing high risk meds for elderly
Health literacy
Others?
Questions for you
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To what extent have you worked
collaboratively with a local pharmacist?
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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?
Other suggestions or questions?