Measurement of pharmacy quality metrics at the pharmacy level should be our goal.

The issue of pharmacy quality measurement is one of extreme importance given the current environment of medication therapy management (MTM) services, evidence-based medicine, value in health care, and pay for performance. Community pharmacists have traditionally measured the quality of their work through the use of dispensing error rates and patient satisfaction services. However, pharmacists are now in a better position to measure the quality of their work based on their performance on various clinical metrics rather than solely based on dispensing a medication order correctly. Given the fact that the health care system is still spending $1 to address problems caused by medications for every $1 that is spent on medications,1 it is imperative that pharmacists continue to do more to improve patient health outcomes and thus decrease overall health care spending. We also need to move with due haste to implement pharmacy quality metrics because of the current move toward health care reform that is occurring at the national level. Nearly everyone seems to agree that our current health care system is in need of repair; however, distinct differences of opinion exist regarding the changes that should be made. Better use of pharmacists in improving the health care system and health outcomes for patients is of doubtless importance to reforming health care. The valuable role of the pharmacist in health care has been demonstrated in numerous studies examining the improved outcomes resulting from pharmaceutical care, disease management, or MTM services provided by pharmacists.2,3 But pharmacists also need to be recognized for the value of the services they provide every day to millions of patients during the dispensing process. The metrics that were created by PQA, a pharmacy quality alliance, and validated by the National Committee for Quality Assurance are things that community pharmacists already are doing or can easily integrate into their prescription-checking process. Having pharmacists measure and report on the quality of care they provide as part of dispensing medications would not only provide a means for pharmacists to continue to improve the quality of their work but also help patients and other consumers to have a better appreciation for what pharmacists do behind the counter. Gone would be the days of the stereotypical image of a “count, pour, lick, and stick” pharmacist. Therefore, I would like to commend Pillittere-Dugan et al.4 who have, with their article on development and testing of performance measures for pharmacy services in this issue of JAPhA, brought a critical issue to the attention of the pharmacy world. Although not a research study in its true sense, the authors provide a good case study approach describing the quality metric creation and validation process. However, one area in which the article falls short is that it gives the impression that health plan level measurement is the only reasonable approach to quality measurement of the pharmacy. While I agree that measurement at the pharmacy level would be difficult, I believe that this challenge can be overcome. In fact, finding a solution to this problem is imperative. Although analysis of the metrics at the health plan level is a good starting point, it does not provide the community with the information that is really needed—namely, the level of quality of the entire pharmacy. The authors admit that they could not measure the quality of pharmacies that were contracted with smaller health plans. For larger plans, they could only measure the quality of about 10% of contracted pharmacies. If health plans are going to use the quality metrics results for pay for performance, this would create an inherent payment disparity for the 90% of pharmacies that may be providing excellent care but cannot be rewarded for it. Further, the authors propose the merging of data from multiple health plans as a way to solve the problem of low numbers of pharmacies. However, that approach has at least three problems. The first is the obvious reluctance of plans to share their data with external entities. The second is the impractical nature of the large number of separate aggregations that would be necessary for a national or even a regional plan. Given the large number of small plans, a national plan might have up to 50 different sets of aggregated data that need to be run (i.e., one set for each state). The third problem is the cost to the plans, especially national plans, to pay for all of this data aggregation and analysis. Pharmacy quality improvement is too important an issue to be limited to only 10% of pharmacies. We have a number of great minds in academia and elsewhere who could take up the challenge of finding a cost-effective means to measure the quality of care provided by all pharmacies, or at least the vast majority of them. Pharmacies deserve it, and so do our patients.