PQA is investigating the barriers and facilitators of prescription turnaround time in the specialty pharmacy setting.

It’s an important issue because prompt treatment initiation is essential for optimal management of complex conditions. Specialty pharmacy prescription turnaround time commonly refers to the time between a specialty pharmacy receiving a new prescription and that prescription being ready for pick-up or scheduled for delivery. Having a prescription ready for pick-up or scheduled for delivery is a key element to treatment initiation, and recent studies have demonstrated a link between rapid treatment initiation and improved outcomes in some patient populations, such as in persons living with HIV.

Welcome to the fourth edition of Five For Friday. We are less than one month away from the 2021 PQA Annual Meeting, May 11-13.

We're disappointed we can't gather in person, but excited about the program we've assembled. We'll present 15 educational sessions that will equip you for success as we emerge from the COVID pandemic.

PQA’s education programs are designed to expand knowledge and develop medication use quality skills. Our Medication Use Quality CE program, our Annual Meeting and the monthly Quality Forum Webinar series are just three of the ways we showcase best practices and novel approaches to improving medication safety, adherence and appropriate use.

Pharmacists and other health care professionals from across our care system – and in a wide range of settings – play important roles in medication use and medication services.

Welcome to the third edition of Five For Friday. As I reflect on my first two months as your CEO, I am pleased to share that my two primary assumptions about PQA have proven to be true. 

First, our membership is incredibly broad, diverse and essential to PQA’s success. As our members, you are our lifeline, and your knowledge, expertise, and engagement in PQA programs, events, and activities continue to shape our path forward. 

PQA’s Board of Directors represents a diverse group of thought leaders and experts in healthcare, who understand how medication optimization improves patient outcomes and supports a value-based care system. Their expertise helps PQA advance the safe and appropriate use of medicines. This blog is one in a series profiling PQA's Board members. 

Jerry Penso, MD, MBA, is PQA’s Board Chair for 2021. He is President and Chief Executive Officer at AMGA, and has been a member of the PQA Board since 2016. Earlier this month, he shared with us his background, experience and insights on PQA's work. 

PQA is a non-profit organization with 250 diverse members across healthcare. Our members include community and specialty pharmacy organizations, pharmacists and other healthcare providers, pharmacies, health plans, pharmacy benefit managers, life sciences, technology vendors, government agencies, health information technology partners, researchers, accrediting organizations and academia.

New organizations regularly join PQA throughout the year. This blog recognizes seven organizations that have joined PQA since November:

The nation’s leading health care organizations come together through PQA to improve medication access, adherence, safety and appropriate use. Our work is essential for high-quality, value-based care. 

We celebrate our individual and collective efforts to improve patient care and outcomes. This week, we're sharing three ways our members are addressing the needs of underserved populations in COVID-19 care and beyond. 

It’s my pleasure to personally invite you to join us at the 2021 PQA Annual Meeting, which will take place online, May 11-13. While we are all looking forward to the time when we can meet together face-to-face, we are excited to continue to host this important meeting virtually and provide you with high-quality educational programs and events which meet your needs.

Our team is hard at work putting the final touches on the Annual Meeting program. PQA’s collaborative approach to quality makes its meetings a preferred destination for quality improvement professionals. The educational programs were informed by our members and will bring together thought leaders for critical conversations on issues which are top of mind for you.  

PQA endorsed two new diabetes-focused health plan performance measures in December 2020. More than 34 million Americans have diabetes, according to the Centers for Disease Control and Prevention. These measures will help evaluate the quality of care for a disease that annually costs America $327 billion.

Ben Shirley, PQA's associate director of performance measurement, provides insights in this Q&A blog on the measures, the quality gaps they address, and PQA's work to develop pharmacy performance measures for diabetes.

The nation’s leading health care organizations come together through PQA to improve medication access, adherence, safety and appropriate use. Our work is essential for high-quality, value-based care. 

We celebrate our individual and collective efforts to improve patient care and outcomes. Every other Friday, we will share three examples of our members' exemplary work, a high-impact PQA project, and ways you can be involved in our work.

The PQA Quality Forum Webinar is a regular, recurring series on healthcare quality topics with a focus on medication use and medication services. It is a forum for educating and engaging with PQA members and quality-focused healthcare professionals.

PQA’s January 21, 2021, Quality Forum welcomed a panel of experts to discuss best practices to support tapering patients on long-term opioid therapy (LOT) for chronic non-cancer pain (CNCP) in out-patient settings. While the presenters noted more research is needed on the long-term benefits and side effects of opioid tapering, the results thus far have been promising.

Aisha Salman, MPH, a Program Officer at the National Academy of Medicine (NAM), began the conversation with an overview of the organization’s Action Collaborative on Countering the U.S. Opioid Epidemic.

Salman noted the severity of the opioid crisis in the U.S. Over 130 Americans die from an overdose every day, and 2.1 million people suffer from opioid use disorder. The opioid crisis cost $2.5 trillion between 2015 and 2018, and costs have been rapidly rising due to COVID-19.

In response, the NAM Action Collaborative seeks to apply a portfolio approach to address the epidemic, recognizing that no single policy will be enough. Established in 2018, the Action Collaborative is a public-private partnership with more than 60 participating members. The goal is facilitating a cohesive, systems response to the opioid crisis.

“We accomplish more when we work together,” Salman said. “It illustrates the necessity for a systems response to address a public health crisis like the opioid epidemic and underscores the important role that the Action Collaborative plays within this ecosystem.”

The Action Collaborative has four focus areas, each with a designated working group:

1. Health professional education training
2. Pain management guidelines and evidence standards
3. Prevention, treatment, and recovery services
4. Research, data and metric needs

Salman focused on the “Pain Management Guidelines and Evidence Standards” working group, which aims to strengthen critical aspects of pain management, including patient-centered and evidence-based tapering guidance, and support the implementation of pain guidelines into practice. The group actively identifies practice and system-level gaps in chronic pain care through a person-centered journey map.

Anna Legreid Dopp, PharmD, CPHQ, the Senior Director of Clinical Guidelines and Quality Improvement at ASHP, followed with more information on NAM’s discussion paper on tapering best practices for opioid users. The NAM discussion paper focuses particularly on patient populations of long-term opioid use who are being treated for chronic non-cancer pain in the out-patient setting. The paper examines the potential of tapering strategies as a form of risk reduction for opioid use and pain management.

Dopp presented the medication-related content contributed by her organization for the paper, which includes the use of non-opioid medications for pain management, managing withdrawal symptoms, and approaches to tapering. ASHP hopes to offer guidance to the Action Collaborative on the ways in which pharmacists can be leveraged in pain management and opioid recovery strategies.

Dopp gave the example of the Support Team on Site Resource for Management of Pain (STORM), which is a pharmacist-led opioid tapering program. So far, STORM-assisted patients have achieved a greater than 50 percent average decrease in morphine milligram equivalents from baseline in 11 years of tracking.

Robert “Chuck” Rich, Jr., MD, FAAFP, continued with a discussion of the paper’s key points and best practices on tapering, current research gaps, and future research priorities. Rich said there are numerous evidence-based benefits of tapering, including lessened risk of accidental overdose, lessened side effects from opioid use and improved pain and functioning. However, there are risks that should be discussed with a patient prior to beginning the tapering process, such as unmasked opioid dependency and behavioral health conditions in patients with long-term use.  

Tapering is not a “one size fits all” process, Rich said, and the speed of tapering will vary from individual to individual. The current consensus is that the higher the dose and the longer the duration of use, the slower the taper. Adjuncts to tapering, though they still require further research, include nonpharmacologic therapies like CBT and chiropractic therapy alongside pharmacologic therapies.

The goal of adjunctions is to optimize pain management, so opioids have less utility for pain control and to optimize treatment of coexisting conditions that impact pain control. Consistent communication between the patient and provider during the tapering process is key.

When establishing the endpoint of tapering treatment, Rich named three main considerations:

As we celebrate Black History Month, I am reminded of one experience that had a profound impact on my view of health access and the pharmacist’s role in addressing medication use quality through team-based care.

In December 2016, I had an opportunity to travel to Los Angeles to spend a few days learning from barber Eric Muhammed, Dr. Ronald Victor, MD, and the healthcare team at Cedars-Sinai. Eric, Ron, several pharmacists, and their research team were working together to implement a barbershop hypertension project to address undiagnosed or sub-optimally treated hypertension in African American men. 

Participating barbers received training on how to initiate the conversation and screen for high blood pressure. If the individual had undiagnosed or sub-optimally treated hypertension, the barber would then contact the pharmacist and connect them with the patient. The pharmacist performed an assessment, such as a comprehensive medication review, and managed the individual’s hypertension. 

The prespecified primary outcome was systolic blood pressure. Secondary outcomes included diastolic pressure, rates of meeting blood-pressure goals, numbers of antihypertensive drugs, adverse drug reactions, self-rated health, and patient engagement according to a validated instrument. The results were not only statistically significant, but also applicable to practice improvement.  

You might have read about this project, but I wanted to share some observations through our lens of medication use quality. Here are a few aspects of this project that make it unique and impactful:  

Micah Cost, PharmD, MS, is PQA's CEO. Today begins his third week leading the organization. This blog features the message he shared with PQA members on February 1, his first day in charge. Follow Cost and PQA on Twitter for more insights on the organization's daily work to improve medication use quality.

The PQA Quality Forum Webinar is a regular, recurring series on healthcare quality topics with a focus on medication use and medication services. It is a forum for educating and engaging with PQA members and quality-focused healthcare professionals.

PQA held an October 15, 2020, webinar on Pharmacist-conducted Immunization Assessment and Documentation.

As today marks my final day at PQA in the role of CEO, I have taken some time to reflect on the past 15 years, and the opportunity that was presented to me in 2006 to build and lead a multi-stakeholder organization, the Pharmacy Quality Alliance. We set out to build a sustainable model for advancing the safe and appropriate use of medications through the development of meaningful and actionable quality measures that all stakeholders would have an opportunity to shape through a consensus-based process.

The path to build PQA was challenging, rewarding, gratifying, and at times humbling. I recognize those who championed its formation including Dr. Mark McClellan, the former administrator of CMS, Larry Kocot, the Senior Advisor to the Administrator of CMS, and other major leaders across healthcare sectors that put their time and energy into the formative years of PQA and ensured its successful launch. The founding members, including AHIP, NCPA, NACDS, AMCP, and AHRQ were among the first entities to help shape the mission and vision of the organization and I am truly grateful for their support.

PQA’s Strategic Plan for 2021 is focused on three, timely initiatives for medication use quality: the social determinants of health, innovative pathways for measure development, and immunization services.

PQA’s Strategic Plans historically have covered three-year periods. Our current plan will reach its successful conclusion at the end of 2020. As we contemplated PQA’s next plan, in the midst of the COVID pandemic, we recognized the value of creating a one-year Strategic Plan “burst” that is relevant for this unique and challenging time – and the needs of our 250 multi-stakeholder members.

Anna Legreid Dopp, Senior Director of Clinical Guidelines and Quality Improvement at ASHP, spoke at PQA’s Data and Interoperability Advisory Group (DIAG) meeting on June 22. She discussed Electronic Clinical Quality Measures (eCQMs) and how we can use them to start thinking about pharmacy measures. ASHP is the organization that represents pharmacists who serve as patient care providers in acute and ambulatory settings.

This blog provides an overview of Dopp’s presentation. You can view a recording of the DIAG meeting and read more about it in a PQA blog, which outlines PQA’s work to address data infrastructure, standards and interoperability.

Amber Baybayan, a Senior Clinical Services Associate at OutcomesMTM, spoke at PQA’s Data and Interoperability Advisory Group (DIAG) meeting on June 22. She discussed data integration in medication therapy management.

This blog provides an overview of Baybayan’s presentation. You can view a recording of the DIAG meeting and read more about it in a PQA blog, which outlines PQA’s work to address data infrastructure, standards and interoperability.