Evaluation of quality circles between physicians-pharmacists
Creators: name: Kohler, Andreas
name: Michel, Katharina
name: Kobler, Irene
name: Schärer, Xavier
name: Arnet, Isabelle
name: Liberatore, Florian
Publisher: name: ZHAW Zürcher Hochschule für Angewandte Wissenschaften
Year: 2024
Subjects: 362.1041: Gesundheitsökonomie

description: Background: In physician-pharmacist Quality Circles (QCs), pharmacists as moderators inform general practitioners and pediatricians about evidence-based guidelines recommended by pharmaSuisse (i.e., the association of pharmacists) and discuss with them the implications for prescription decisions. The QCs are financed and administrated by the Research and Quality Fund (QFF) of the “Verwaltungskommission des Fonds LOA” (VKF), which is funded by compulsory health insurance premiums according to formal criteria regarding the constitution and documentation of the QCs. The QCs are geographically concentrated in Western Switzerland and Ticino.
Study Objective: The aim of this evaluation study was to analyze the effectiveness, appropriateness, and economic viability (WZW) of physician-pharmacist Quality Circles retrospectively and to give recommendations for optimization.
Data Sources: Economic viability and effectiveness of QCs was evaluated based on a combination of SASIS data, data from a non-representative moderator survey and “messages aux Médecins”. The latter two data sources were selected due to missing protocol data from the QCs. Appropriateness was assessed based on results of non-representative surveys and qualitative interviews of moderators and physicians.
Methods: Economic viability was evaluated using methods of causal inference (i.e., entropy balancing). For the evaluation of effectiveness a case study approach is suggested. Appropriateness was evaluated based on descriptive analyses of non-representative surveys among participants of QCs, content analyses, and qualitative interviews with participants of QCs.
Results: Due to data limitations effectiveness was not evaluated but a case study design proposed for future evaluations to assess effectiveness of QCs (i.e., changes in prescription behavior due to QC participation). Regarding Appropriateness, respondents of the surveys valued the interprofessional exchange in the QCs. However, they stated some recommendations for optimization of the scope and format of QCs. There is suggestive evidence for the impact of QCs on economic viability. Physicians enrolled in QCs have on average lower indirect drug and total laboratory costs per patient as well as a higher indirect generic drug share compared to physicians not enrolled in QCs after making groups comparable in terms of physician and patient characteristics.
Limitations: The study is subject to several limitations due to incomplete and missing data that must be considered when interpreting the results. (1) No information was available on whether a physician had actually participated in the QC sessions. Therefore, participation was assumed. (2) Information about enrollment in QCs was only available for two years. Thus, it is not possible to use methods of causal inference that allow to control for unobserved char-acteristics (e.g., difference-in-differences). This implies that the estimated impact of QCs on economic viability might be overestimated (or underestimated) due to residual selection bias (3) Due to missing protocol data, information about topics discussed in the QC sessions were gathered retrospectively by a survey among moderators (assumed recall and social desirable bias and non-response bias). (4) Survey results arealso biased due to sample selection issues (low response rates, assumed response bias due to proportionally more responses from still participating physicians and still moderating pharmacists vs. no longer participating physicians and no longer moderating pharmacists). Therefore the surveys are not representative and do not allow a generalization of the results In Sum, limited information was available about which physicians have been treated (i.e., participated in QCs) with what kind of treatment (i.e., topics discussed in QCs).
Outlook and Recommendations: The methodological approach of the study offers a basis for the future evaluation of the QCs according to the WZW criteria. Future evaluations of the QCs need better data quality (information about participating physicians and discussed topics) provided by standardized protocols (designed such that they can be used for evaluations). The VKF should specify the goals (i.e., specific, measurable, achievable, relevant and time-bound SMART) of QCs, review framework conditions (i. e. administrative requirements for moderators, remuneration settings and SASIS data delivery) and discuss a potential redefinition of the scope of QCs (beyond cost savings, also include objectives such as optimized medication decisions, improved communication and intensified interprofessional exchange).