PQS Quality Corner Show
Join Pharmacy Quality Solutions Associate Director of Pharmacy Accounts Nick Dorich, PharmD, for a podcast series "Quality Corner Show" that covers everything quality in the world of pharmacy and patient care. Look for future episodes to interview guests and experts in the healthcare profession.
PQS Quality Corner Show
Highlights from the 2023 Trend Report in Pharmacy Quality
The PQS Quality Corner Show welcomes back PQS Director of Analytics and Program Development Andrew Thorne, PharmD, MS, to talk about findings from the 2023 Trend Report in Pharmacy Quality.
Thorne first breaks down the first chapter of the report that studies the impact of socio-demographic factors, including age, gender, and low-income subsidy (LIS) status, on adherence rates for Cholesterol, Diabetes, and Renin Angiotensin System Antagonists (RASA) Proportion of Days Covered (PDC) measures.
He then talks about the trend report examines how adherence can be impacted by factors such as drug switching within a measurement year and the utilization of extended fills.
Download the 2023 PQS Trend Report in Pharmacy Quality
00:00:01:08 - 00:00:20:20
Andy Thorne
And we went into this with the hypothesis that the patients who are on extended floors would show higher measured rates, and that was borne out. The large majority of patients as well, and this was interesting to me, I didn't realize how much this was, but the large majority of patients in all of these measures were already receiving only extended files.
00:00:20:22 - 00:00:40:23
Andy Thorne
It's a large percentage. So for cholesterol, PDC, for instance, which I keep coming back to because it just has the largest number of patients to look at in the measures. Nine, 9.2 million of the patients were on only extended pills throughout the year. They didn't get any non extended fills for their cholesterol, for their study.
00:00:41:00 - 00:01:06:00
Intro
Welcome to the Pharmacy Quality Solutions Quality Corner Show where quality measurement leads to better patient outcomes. This show will be your go to source for all things related to quality improvement and medication use and health care. We will hit on trending health topics as they relate to performance measurements and find common ground for payers and practitioners. We will discuss how the equipped platform can help you with your performance goals.
00:01:06:02 - 00:01:37:23
Intro
We will also make sure to keep you up to date on pharmacy quality news. Please note that the topics discussed are based on the information available at the date and time of reporting. Information or guidelines are updated periodically and we will always recommend that our listeners research and review any guidelines that are newly published. Buckle up and put your thinking cap on the Quality Corner Show starts now.
00:01:38:00 - 00:02:03:21
Speaker 3
Hello Quality Corner Show listeners. Welcome to the PQS podcast, where we focus on medication, use, quality improvement and how we can utilize pharmacists to improve patient health outcomes. I'm your host, Nick Dorich, and welcome to our first podcast, our first show of the 2024 calendar year for this show today. I'm excited to be talking about the Pharmacy Quality Solutions or PQS 2023 Trend Report.
00:02:04:02 - 00:02:15:16
Nick
So for that, I'm going to be bringing on board one of my teammates here at PQS, Andy Thorne, and he's been on the show before, but we're pleased to have him back. And with that, Andy, how are you doing today?
00:02:15:18 - 00:02:26:03
Andy
I'm doing well. We've had a good year, a good new year. Looking forward to many new things in this coming year. But proud to have put out a good report and happy to be here to talk about it today.
00:02:26:05 - 00:02:42:02
Nick
Excellent. So before we get into that trend report, Andy, let's get a little bit about you, your background. You are you are one of the pharmacists like myself here at U.S. But what is it that you do here at PQS and a little bit about what you've done in your career before your time at PQS?
00:02:42:04 - 00:03:24:03
Andy
Yes, one of the few, the proud. So I came to PQS about two and a half years ago. So coming up on my third year before I came to PQS, I was practicing primarily in hospital settings and in management and leadership. So after pharmacy school, I did some residency training in health systems pharmacy administration. From there, then I managed the clinical trials pharmacy at the University of North Carolina Health for there for health system and then came to PQS as initially really focusing as a measured subject matter, expert leaning on some of my past clinical experience from school and otherwise training to give some context to the folks typically who are
not pharmacists who have not been in health care settings, who make the software to help translate some of the clinical aspects of the measure spec so that everything that we're doing is meeting that measure specification intent. So I continue to be the measure subject matter expert, but also I have taken over leading the trend report and some of our scholarly efforts here at PQS as well as analytics.
00:03:46:08 - 00:04:05:00
Andy
In the last year I've also been helping out with some program development, especially within our Enhanced Services within EQUIPP we we will you have with others talked about that in other podcasts. That's not our focus today. Our focus today is more around some of the analytics that I lead and how that relates to the scholarship and the trend report as well.
00:04:05:02 - 00:04:22:16
Nick
Man, that wears many hats and will continue to do so here in 2024. All right. Well, Andy, before we before we jump into our questions for today, we're going to pause very quickly to hear a quick message and the breakdown from our teammates at PKs.
00:04:22:18 - 00:04:47:05
Breakdown
Now it's time for the breakdown as Quality Corner show host Nick will ask three main topic questions. Our guests will have a chance to respond and there will be some discussion To summarize the key points This process will repeat for the second and third questions, which will wrap up the primary content for this recording. After that, I expect to end on a closing summary, usually containing the bonus question.
Now that we have described the process, let's jump into the questions.
00:04:53:21 - 00:05:20:15
Nick
All right, Andy, we're ready to jump into our questions and our topic for today's episode. And we are talking about the 2023 PQS quality Trend report. Before we go into the questions, we need to first tell folks, what is this report? Where can they find it and just what some of the background. So I'll hand it off to you here so you can give us the background information or description and then of course, where they can find the report when they want to look into it and dig into all the deeper details that we're not going to be able to cover on the show today.
00:05:20:19 - 00:05:49:13
Andy
Yeah. So this this most recent publication of the Trend report in 2023 was the fifth Annual Trend Report. So it started before my tenure with PQS. Todd was very involved in getting it off the ground in 2019. So 2019 was the first year for the trend report and that year focused on surveys of consumers and pharmacies and health plans around what they're doing within the space of of health care and and quality to improve quality.
00:05:49:15 - 00:06:10:24
Andy
We've continued that format for the trend report. But then we've also introduced some odd years and right now we're doing a structure where we do one one year and then the other the other year and kind of a tick tock fashion. This last year we focused on specific questions. We wanted to have a through line theme, do some analytics on that theme too, to answer some questions that are relevant to our industry.
00:06:11:01 - 00:06:45:04
Andy
The trend report overall really tries to set a a standard level of or standard language, maybe a standard framework for us to talk about the things that we do within our industry. We have shared vocabulary, we have shared ways that we talk about things, but we can sometimes come at it from different perspectives and we try to represent those perspectives within the trend report and give us all a base from which that we can work to see what's happening in the market, what people are doing, maybe respond to that, maybe foster some ideas within the different groups in in quality and medication related quality.
00:06:45:06 - 00:07:01:13
Andy
And we are proud to continue that. We're looking forward to another trend report in 2024 in early concept for that now, which I think we'll talk about a little bit later, but it's something that we publish once a year, but we kind of work on throughout the year. We publish one year and then we start on the next one.
00:07:01:15 - 00:07:26:22
Nick
Excellent. So yeah, I definitely recommend everyone. If you're listening to this podcast while you're driving, please hold off on going on downloading the report until you are parked in your car, but definitely recommend that everyone goes and checks out. Check out the report. You can download the trend report from pharmacyquality.com for this trend report. And actually all of the prior trend reports that Andy had mentioned can all be found on the resources dropdown from the site.
00:07:26:24 - 00:07:53:22
Nick
So with that, Andy, we're going to jump in. We're going to jump into our conversation for today and talking about the report. I've had a chance to go through and read it myself and it really is broken down into two different chapters as it relates to medication use and the state of quality. So we're going to spend some time on each of those chapters, and then we're also going to spend some time to, as you mentioned, we're going to give a little bit of a look ahead into what could be some of the topics or considerations for research in the 2024 report.
00:07:53:22 - 00:08:23:08
Nick
So that's the format for today's conversation. And with that, the first chapter of the of the 2023 Trend Report that really focuses on a topic that has been very popular in pharmacy and in health care, this is going to be relating to social determinants of health and how that can impact patient health outcomes. So what have we learned recently and what did we tease out from this report about how sociodemographic factors can impact medication adherence in particular?
00:08:23:10 - 00:09:03:17
Andy
Yeah, you make a good point that for this trend report we are focused on medication adherence specifically for for diabetes, statins and RASA agents. So kind of the three adherence measures that are a part of the Part D Stars program, that's been a big focus. And for those we wanted to ask the question, do patient demographics or socioeconomics factors correlate in any way with adherence, with a mind towards: Are there things that we can do that are predictive or that we can identify populations using these things, that we can proactively help them to be better with their medication adherence rather than reacting after the fact?
00:09:03:19 - 00:09:26:03
Andy
And for this, we, of course, initially wanted to shoot for the moon to include just about anything we could think of in terms of social demographic factors or economic factors. But I probably won't I won't surprise our listenership that a lot of those data are not very accessible, They're not very consistent. And we wanted to do a very, very large sample.
00:09:26:05 - 00:09:49:20
Andy
We have, we are lucky to have access to a very large data set in terms of pharmacy claims, and then we calculate those in-house to to produce measure results. So we wanted it to be at really as close to the population level as we could. So we focused on things that we were confident in, specifically age, gender and economic status, or really a surrogate for economics status, looking at low income subsidy eligibility.
00:09:49:22 - 00:10:13:08
Andy
And across those three elements, we found that there are differences. So we'll focus first on age. There's been other research done for all of these things. Nothing that we're looking at are questions that haven't been asked before. But like I say, we feel that we're we're uniquely asking them from a very large population perspective to to put it into perspective.
00:10:13:08 - 00:10:36:15
Andy
We've got across these different measures for the cholesterol measure. In particular, we're looking at over 13 million patients. We're included into the analysis that produce these outcomes for diabetes. It's over 4 million patients and for us it's over 11 million patients. All right. So to come back to the results we saw for age, we saw that there was a higher mean age among adherent patients.
00:10:36:21 - 00:11:00:15
Andy
So those patients who were adherent across all of these measures had a higher average age, and that was not a real shock. There has been other research that has shown that what this research or what what our analysis doesn't do is give a real distribution to see is like, is that a spike at that age or what is the tail on the younger ages or higher ages?
00:11:00:17 - 00:11:30:20
Andy
We tried to approximate that by using buckets, so also for age, we looked at those that were less than 65, those that were 65 to 74, and then patients who are over 75 or 75 or older. And for those we found that age less than 65 had the lowest adherence, but also by far the smallest population. Consider that a lot of this data is related to Medicare and those that are in Medicare have the more accessible data they are.
00:11:30:20 - 00:11:51:00
Andy
If they're younger, they're often not a traditional Medicare patient. So those weren't shocking. And we did see that in some measures. It was roughly the same for the age group of 65 to 74 as it was for 75 plus. But for cholesterol, for instance, we saw that the best measure rate as a population was in the age 75.
00:11:51:00 - 00:12:12:14
Andy
Plus, contrast that with RASA PDC, where we saw that the highest adherence was age 65 to 74, but we're talking about about a 1% difference between those different buckets. So age makes a difference. But we didn't see in these large populations that it made more than a difference of about 0.5% or 1% one way or the other.
00:12:12:16 - 00:12:38:15
Nick
Got it. So in Andy, as it relates this information, you mentioned that this isn't necessarily this is not actually items that have not been researched before, but we actually covered in an episode just a few months ago talking about medication adherence and other factors that sometimes adherence or sometimes research or data excuse me, that can be used in developing new services or new programs or developing even public policy can be sometimes outdated.
00:12:38:21 - 00:13:08:09
Nick
So, you know, it is it is important for us to take a fresh look at this kind of information and to identify are we still experiencing the same sort of trends as it relates to medication adherence and impact on social determinants of health or how gender or age may be impacting adherence, you know, from those matters. So I think this information, as you talked about and this is also generally a pretty large dataset across millions of for the health plans, 6 million of their members pharmacies, millions of their patients that released this information.
00:13:08:11 - 00:13:29:03
Nick
So not really anything new, perhaps, but really just reinforcing that this adherence needs to be a continuous process, a continuous journey for the patients, whether they're age 30, whether they're age 65, and just hitting Medicare or whether they're age 75 or 75 plus. Anything you want to add to that as kind of takeaways before we get into our next section?
00:13:29:05 - 00:13:49:23
Andy
Now, really just to say this is part of the conversation and we hope that because this is as close as we can really get to the true population to analyze the true actual population, but it augments or enhances some of the research that's been done sometimes in a more deep way, but with a smaller population thinking. Then we also looked at gender and we again with gender, found a difference.
00:13:49:23 - 00:14:14:06
Andy
And for the diabetes PDC measure, we found a difference of 1.5%. That was the largest difference for cholesterol, it was 1% and also PDC, it was 0.3% for cholesterol and diabetes. A little bit. Bucking some stereotypes, the male populations had higher adherence than the female population. RASA, PDC was the other way around, but that was the smallest difference that only 0.3 percent.
00:14:14:06 - 00:14:37:19
Andy
So it's, you know, we traditionally within our culture think that the female patients are better with follow up. They're more likely to go to the doctor somewhat. This doesn't disprove that because these are only patients who have been to their doctor. They're getting the medications but did see a slightly higher adherence among men than for women. When we looked at economic status or, as I said, the surrogate of low income subsidy eligibility.
00:14:37:21 - 00:15:04:04
Andy
We also saw a difference there. And this was the same direction for all of the measures where those patients who were not low income subsidy eligible. So we would we would assume those patients have better socioeconomic status, that they had higher measured rates as a population. Those that were less eligible had slightly lower rates. This was in a couple of cases, the largest difference between rates that we saw.
00:15:04:06 - 00:15:32:11
Andy
Raza PDC was the largest of 88.6 versus 84.8. So nearly a four percentage point difference. But it will also call out the low income subsidy. Eligible population is much smaller than the population that is not low income subsidy eligible. And you know, good to see that for everything. Measure rates were above 80% still had as the lowest rate here 84.1% measure rate among less eligible in this population.
00:15:32:11 - 00:15:51:17
Andy
So as we've seen and I think you and I have talked about possibly on another episode here, there's been an increase in performance for these measures across the market in the last 12 or so years that these have been a focus. So we're seeing that. And even in some populations where you might expect that the measure rates wouldn't be as good.
00:15:51:19 - 00:16:15:18
Nick
Yeah, absolutely. So an item where, you know, more information here to confirm more information here that perhaps gives us some additional details and is worth additional follow up. But Andy. Well, that is chapter one and focusing on the patient, the patient factors, the demographic information that's there chapter to which we're going to move to now focuses more on how patients utilize medication.
00:16:15:20 - 00:16:45:06
Nick
So for my own experience, and I've been here at Pharmacy Quality Solutions for over nine years, I often get questions, comments or critiques from folks talking about, well, you know, the medication or medication adherence that doesn't take into account how folks use medication or if medications change or if they have change. And there are some truth and there are some myths that go to many of those questions, because these are measures that and you and I both know, these are measures that look at a class of therapies.
00:16:45:06 - 00:17:06:22
Nick
So for the cholesterol or statin measure adherence as an example, it's looking at the statins that the patient may use. Anyways, Chapter two looked at medication utilization. And so really key factors, some items that have come up as I guess maybe frequently asked questions that we've gotten from pharmacists, from public health officials or folks that are working in a health plan.
00:17:06:24 - 00:17:14:01
Nick
So I'll let you take it away from here. But what were some of these utilization factors that were kind of high on our list that we that we looked into?
00:17:14:03 - 00:17:46:14
Andy
Yeah. And I'm going to I'm going to talk through just at a high level the things that we talked about. But to keep myself from talking for an hour, I'm going to focus in on on a subset of those things that are in the report. We looked at, as you mentioned, things that are structural, things that are how the medications are being received, what the medications are, what is the duration of the pill that the patient is getting, things that can be, you know, kind of driven either by patient choice or by policy, either by the pharmacy or the health plan to see if those things can be indications of populations that may struggle.
00:17:46:16 - 00:18:06:06
Andy
So we looked at switching drugs within a measure. So if you're taking simvastatin you switch to a toward statin. Just does that make any change in measure rates as just as an example how patients are getting their medication, the duration of their feels extended fills versus not extended fills? Whether a member is new to the health plan was one thing we looked at.
00:18:06:08 - 00:18:27:07
Andy
And what is the overlap or interplay between the measures? Because we know that there are a lot of patients who have diabetes, hypertension and high cholesterol and are hitting all three of these measures, or there are some who may be unlucky to have diabetes, but they don't have high cholesterol and they have high hypertension. You know, maybe there's a difference with it.
00:18:27:07 - 00:18:51:19
Andy
We can see it in those. And we examined all of these questions. So I'll pick like three or so of those to talk through. And starting with switching drugs within a measure. So we hypothesized going into this that if you are switching drugs within a measure, so say you're on a statin, you're having some side effects from that statin and you work with your doctor to change your stat into another.
00:18:51:21 - 00:19:10:18
Andy
There's some reason to think there that like you're having a lot of interaction with your provider and that may mean that you have higher adherence because you're paying more attention to your medications. But on the flip side, you're also changing your medication, changing your routine. You were having side effects, so maybe you weren't taking it for a little while before you could get a new switch medication.
00:19:10:18 - 00:19:38:23
Andy
So we might see lower adherence among those patients. So that's part of the reason we wanted to look at it. We didn't look at diabetes PDC here because you can be appropriately on multiple medications for diabetes, but within the other two measures, you're really just going to be on one. So we looked at the number of ingredients that a patient had been dispensed for those measures over the course of the year, and we found that measure rates were lower when we were looking at only those patients who switched target medications within a measure.
00:19:38:24 - 00:20:04:17
Andy
So the thought that you're having side effects, you may not be taking it for a little while or there is increased complexity. When you switch something, you're not quite sure how to take it. That does seem to have had an effect. And we saw that for cholesterol, PDC, for instance, I'll call it these numbers, those patients that had just one drug had a measured rate of 86.8%, and those who switched within the measure here had a measured rate of 79.6%.
00:20:04:20 - 00:20:26:22
Andy
So there we see about a seven and a half percent measure rate difference, which is fairly significant when you think about these groups. But I should also call out here those that were on one drug was about 12 and a half million patients. Those who switched was 470,000. 470,000 is still not a small population, but it's much smaller than those who stayed on the same medication through the measure here.
00:20:26:24 - 00:20:48:03
Nick
And so any if I can perhaps summarize or kind of pull out what what are the key details that are that are here related to it, patients that are going to have a more complex disease state, which this is kind of a proxy for or that may be changing medications. Those are probably patients that need more interaction, more management from their pharmacist.
00:20:48:03 - 00:21:11:16
Nick
And that's really an opportunity where payers and and pharmacies or the pharmacist should be working together in ways to collaborate, to identify, properly, recognize and reward and said these patients can be optimized for therapy and ultimately improve their their health outcomes because these are the patients, as you mentioned, patients who say on a therapy, not that they don't need management, but those are patients that are really kind of on track.
00:21:11:16 - 00:21:35:13
Nick
And hopefully if the patient is tracking towards their health goals, as with their primary care provider, there's not a whole lot of follow up there that should be needed depending on what medication is. You know, check some labs, maybe you might need to check liver function or renal function, that sort of thing, kind of here and there. And for the patients that are switching the medications, this really needs to be a routine check in for you as the pharmacist with these patients.
00:21:35:13 - 00:21:49:02
Nick
And that's something that we always talk about here at PQS. Adherence is not a one time, hey, you do an MTM or hey, you enroll the patient medicine. This needs to be a continuous process. And I think this really just goes to reinforce that thought process that we've been trying to instill.
00:21:49:04 - 00:22:08:17
Andy
Absolutely. And you know, core training, core activity is as a pharmacist patient comes to you there having side effects, talk with them, help them, patient comes to you, they're changing their medication, you know, maybe they have questions, etc.. So this this will not be a surprise to our pharmacist listening audience that that's an opportunity to make a difference in a patient's life.
00:22:08:19 - 00:22:48:14
Andy
And then here we were looking at the population level. At that level, it does bear out that that they have a little bit more of a difficult time. Yeah. Moving on to extended fills was another thing that we looked at. Yes, this is is much talked about. There's lots of research here from you know we interestingly found a lot of usability patient satisfaction research as well as financial research or reporting of a financial impact of extended feels out there in the world and we went into this with the hypothesis that the patients who are on extended floors would show higher measured rates, and that was borne out the large majority of patients as well.
00:22:48:14 - 00:23:08:05
Andy
And this was interesting to me. I didn't realize how much this was, but the large majority of patients in all of these measures were already receiving only extended fills. It's a large percentage. So for cholesterol, PDC, for instance, which I keep coming back to because it just has the largest number of patients to look at in the measures.
00:23:08:07 - 00:23:31:22
Andy
Nine But 9.2 million of the patients were on only extended fills throughout the year. They didn't get any non extended fills for their cholesterol, for their statin. There were 1.4 million patients who got both. They had a at some point a short duration fill and then at another point an extended fill, and then only 700,000 who have had only non extended fills, no extended fills through the year.
00:23:31:24 - 00:23:57:05
Andy
And we saw that the highest rate among those groups was 88.6% of those that had only extended fills, those that had a mix drop the rate down to 80.9% and then those that had only non extended fills was the lowest rate at 75.1%. So we see from those who have only not extended fills to those who only have extended fills, that's a difference of over 13% in the measure rate.
00:23:57:07 - 00:24:16:11
Andy
This was the strongest difference that we saw in the whole trend report was these buckets of those that had extended fills versus those that didn't. Now, I should stop and say I am in no way saying that every patient should be on an extended fill of their medication. There are absolutely circumstances where a non extended feel is the right choice.
00:24:16:11 - 00:24:30:00
Andy
It's clinically appropriate and that's, you know, clinical judgment by physicians, pharmacists, etc. But it's hard to deny that patients being on an extended field does make a difference to their adherence.
00:24:30:02 - 00:25:01:09
Nick
Yeah, And I think, you know, Andy, it's it's a question that is brought up frequently when members of our team are meeting with pharmacists or meeting with pharmacist, it comes up all, hey, do we have to do extended day supplies? One thing I'll point out I think is in, as you said, more patients than not in this in this subset of patients, Medicare patients that are taking medications that fall under management for cholesterol, diabetes or for hypertension, more patients are not are using extended days by fills already.
00:25:01:11 - 00:25:24:10
Nick
And then coupling that with when we talked about, well, how many patients are changing medication during the course of the year, most are staying on the same therapy. So if a patient is on that same therapy, if that is being managed and if they are, you know, having their follow ups with their with their appropriate providers, you know, to to make sure that the disease state is managed and also that there's not any side effects that are there.
00:25:24:12 - 00:25:49:11
Nick
That's that can be that can be that can be noticed the the terminology that can be a tool that is utilized to help manage the patient. And then, of course, if that set up in a way that is also appropriate from your perspective and a pharmacy perspective. So this is something where a lot of folks have been shying away from it, but it is definitely a tool that can be can be utilized.
00:25:49:17 - 00:25:54:14
Nick
Any final comments here before we start to look ahead into the future? And, you.
00:25:54:16 - 00:26:17:00
Andy
Know, just agreement, I mean, it's it's a tool and it's a way to enhance and it's a tool that we should really reach for in terms of enhancing medication adherence and thereby enhancing the quality of care for our patients. But again, it's not appropriate in every case. The last thing I'll focus on that we studied was the overlap of patients between these measures.
00:26:17:05 - 00:26:45:21
Andy
So we we looked at each of the measures and it's one of the most complicated tables in the report. So please don't if you're in a card, don't download the report right now and look at it. But, you know, maybe pull over. This is really exciting. Pull over, download the report. You can look at this table. It's breaking out those that were in each of the measures and also then by where they only in that measure where they end that measure and measure B or were they in that measure in Measure C or were they then all measures?
00:26:45:21 - 00:27:09:06
Andy
So for all of them, we've broken them down in that way. And it's interesting to see that in all cases, the lowest measure rate is for the patients that are in the one measure only. So the lowest diabetes PDC measure rate is for patients who are only in diabetes PDC and that is the smaller end of the population sizes.
00:27:09:08 - 00:27:30:09
Andy
So more of the patients are in more than one measure than are in just the one measure. But again, it's not small populations, it's let's see, this is 400,000, 3 million, 4.7 million. So for cholesterol, for instance, nearly just over a third of the patients are only in the cholesterol measure, and that's the lowest measure rate for cholesterol.
00:27:30:09 - 00:27:59:23
Andy
PDC patients. So this this is interesting. I think it goes a little bit counter to the conclusion that we could draw from the earlier analysis that we talked about, about switching a med within a measure that kind of implies that if your care is complicated by something, that that may reduce your adherence. But typically the highest measure rates of the overlap or for the patients that are in all three measures and they have more complicated care, but then they may also be more used to it.
00:28:00:00 - 00:28:23:08
Andy
They may have been on these medications for longer than the patients who are in just one measure or maybe in just two measures. So this is multifactorial. It's not one thing that is affecting the adherence of patients. We've tried to isolate these questions as well as we can, and they do have indication that something does correlate with adherence.
00:28:23:10 - 00:28:50:00
Andy
I don't think I've made this point already yet, but it's here. Take a step aside. These things are not causing differences in medication adherence. We're really only looking at correlation here with the fact that maybe there are ways that we can identify patient populations that might need extra attention or extra help. And this one really was interesting to me to see that patients with relatively less complex medication therapy that were in just one of these measures had lower adherence.
00:28:50:02 - 00:29:11:19
Nick
And certainly I think it somewhat runs counter to some information or some summaries that have been said to, hey, patients are going to be taking if they're taking multiple medications or multiple disease states, there may be some degree of pill burden, complexity. That's an issue that's there. But some of this information perhaps points to a different answer, a different consideration.
00:29:11:19 - 00:29:34:08
Nick
I think, again, my summary really looking at all this information, is that I'm going to go back to it mentioned this earlier, but really just further goes to show that for these patients and for these patients who are taking a chronic medication for management of a chronic disease, that it is important that they are meeting with their pharmacist, their pharmacy team member, their medication expert on a routine and regular basis.
00:29:34:08 - 00:29:55:10
Nick
This is not a one time fix. It needs to be a continuous process. So, Andy, speaking of a continuous process, we are continuing to evolve and grow the trend report and already mentioned it will be returning for its sixth edition or volume or however you want to put this, but it will be returning in 2024. I assume that you and the team are already underway.
00:29:55:12 - 00:30:07:21
Nick
Do you want to give us maybe, perhaps a peek behind the Wizard of Oz curtain? What are maybe some of the considerations or what have been some of the thoughts that are in play for this next iteration of the report?
00:30:07:23 - 00:30:34:06
Andy
You're right. Lots of discussion, lots of our thoughts already about what we're going to do in 2024. For 2024, we want to revisit the question of or the just the things that we assess through the surveys of consumers, pharmacies and health plans to see what are consumers attitudes about pharmacies and in ways that relate to quality and from pharmacies, What are they doing to enhance quality?
00:30:34:06 - 00:30:56:18
Andy
What are payers doing in their programs to enhance quality? And we try for those considering especially that this is a trend report, we try to change those only in minor ways from prior surveys that we've done so that we can compare to prior years in a meaningful way and that we haven't blown it up and can't trend off of those prior responses.
00:30:56:20 - 00:31:33:07
Andy
When looking at the surveys, there are some things that we want to change. So we're in discussion right now about how we align the population of the survey respondents, particularly on the consumer side, with the patient population that are in these measures. In the past, I think we've struggled a little bit that the age and relative medical complexity of the patients that respond to our surveys or that we can we can get surveys as survey respondents or don't line up quite with the the Medicare population in particular, not that they're the only ones that have medication quality concerns, but that is a lot of what ends up into these measures, of course.
00:31:33:09 - 00:31:59:22
Andy
So we're going to think through those things. We're going to make some revisions to the surveys, but that is in the plan for this upcoming trend report. And then beyond that, I have a lot of really not fully fleshed out ideas of what kind of a special report we could do. I say that every other year we do these consumer pharmacy and payor surveys, but for all of the trend reports where that has been the focus, we've also done a little addendum.
00:31:59:22 - 00:32:20:21
Andy
We've done a little like, Hey, let's ask a little question on the side and for what we might do for that for this year, which is the structure that we're thinking we're going to do for this year, that might change too. But those questions, I don't feel like I have fully formed enough to share as of today, but I'm excited about some of them.
00:32:20:23 - 00:32:37:04
Andy
And it it probably will end up being this year like it has in past years that the questions that we're most excited about end up being the questions that we have the least available or at least reliable data to answer those questions. So we end up, you know, you end up chopping those out even really hurt a little bit to to move away from.
00:32:37:04 - 00:32:59:13
Andy
But I'm excited about this year's report. I think that we have I speak for myself. I have learned through several years of doing the report. I think we're going to make it better. I think we're going to bring out something that will be additionally useful and will augment the things that we've done in previous trend reports. I will also make a call for people listening to this.
00:32:59:13 - 00:33:30:15
Andy
If you've read the report before and it has popped into your mind, why didn't they ask this question or why didn't they do X, Y, or Z? And this way or that way, I want to hear from you. I want to hear your suggestions. I want to hear your thoughts. I would love to know what from the report you have found valuable, what from the report in prior years, you have found really to just be noise you can email trend report at pharmacy quality dot com that will come to me and then you know give us some feedback if there's anything particularly that you want to see in an upcoming report, I want to hear
00:33:30:15 - 00:33:44:07
Andy
about it. And then you may see it in the 2024 report or in future years as well. But overall, Nick, even though I'm kind of dodging your question slightly, we're excited about it. I think it's going to be a good report and we're digging into it.
00:33:44:09 - 00:34:04:04
Nick
Final question that I have for you, Andy, and this one, you may have some specificity to when can folks expect the 2024 report? And aside from, you know, asset picks, publishing the report to have you on our side, do you do you expect that there may be other places where we are talking about it after it's released?
00:34:04:06 - 00:34:33:13
Andy
Yes, absolutely. Our target is always for we this year published in November. Hopefully we can get something out in October this year. But, you know, best laid plans, but definitely the fall because we will again be it's my expectation that we will be partnering with PQA for their quality forum to be discussing that trend report and put out things like this, things like podcast or otherwise to get that out into the world.
00:34:33:15 - 00:34:36:21
Andy
So that's, that's the timeline that we're looking to.
00:34:36:23 - 00:34:58:11
Nick
Excellent. So folks can look forward to this in the fall. And I think last year was November was the release for it and the Quality Forum presentation on the peak. So folks can look forward to that. Of course, if you're listening to the Quality Corner show, well, we'll probably have another episode to cover the 2024 report. I would pencil that into the schedule as I have done literally on my Outlook calendar though.
00:34:58:11 - 00:35:12:10
Nick
With that, Andy, we're going to wrap up today's episode and this is the part of the episode where we get into some questions for our guest. I was going to say personal questions, but we're not we're not asking for your favorite color or what was the name of the road that you grew up on as a child or anything else like that.
00:35:12:12 - 00:35:18:18
Nick
These are meant to be a little bit more fun in nature. So, Andy, are you ready for our questions today?
00:35:18:20 - 00:35:19:16
Andy
We'll see.
00:35:19:18 - 00:35:27:24
Nick
I think first. Yeah, Well, first question, what makes you thankful to be working in the pharmacy profession?
00:35:28:01 - 00:35:56:16
Andy
I the patients you know, I, I have been in roles in past career where I've sat down with individual patients and done you know, I was in an anticoagulation clinic for a little while, so I did a lot of finger sticks and talked a lot about warfarin and we talked about renal function, you know, to then discuss with the patient what their appropriate anticoagulation regimen might be and how they're doing on what they have.
00:35:56:16 - 00:36:26:14
Andy
I love that patient interaction. Since some of those experiences have moved more into leadership management, where I'm slightly more removed from those things, but that I get a chance to set up systems and empower other health care providers, pharmacists or technicians or beyond to do things that they themselves are using to benefit patients. And then here at peak in a technology company, I would say I'm even maybe one more step removed from the direct patient care.
00:36:26:14 - 00:36:47:17
Andy
But we have a reach across the country. And I like to remind myself, and you have done this, Todd has done this and others at PQS to think about what is at the end of what we do. It's really about the quality of the medication management and the care for us, facilitating the best care that we can. And in our particular niche in health care settings across the country.
00:36:47:19 - 00:37:12:19
Nick
Excellent. Our next question here is going to be related to the pharmacy aspect, Andy. So whether it was when you were working in your experience in a clinic and that sort of pharmacy, or if it's in your work today and in our work here at Pharmacy Quality Solutions, what superhero or fictional character would you want to be working along with in your pharmacy experience?
00:37:12:21 - 00:37:51:24
Andy
Geez, you are opening a wide world of possibilities here for a superhero. I don't know. This will be off the beaten path, but I think you'll be a fan. I'm going to say Doctor Who, that's one of the first that comes to mind for me is a bit of a strange superhero, if we're going to be honest, but does a lot of of good and the things that Doctor who is focused on is getting out into the world in various times, various, whatever, and doing good for people and not really with anything that is, well, semi unbelievable.
00:37:51:24 - 00:38:03:23
Andy
You do have to suspend some of your disbelief for any superhero or that type of. But it's it's relatable and it comes back again. It's like we're doing good. We're doing good in the world.
00:38:04:00 - 00:38:25:14
Nick
For our fellow nerds that are listening, I'll clarify or confirm for Doctor Who the series. But it is the doctor is the character follow up question. That was not on my list here. Is there a particular doctor and companion because you get the package deal for getting the doctor, but is there a specific doctor and or there companion that you have in mind with this?
00:38:25:16 - 00:38:47:08
Andy
I'm going to forget the their specific name your by your first correction and then how I'm going to answer this question where you are really elucidating here that I am a a fan but not a deep fan of of this series. But the the the doctor who that first caught my attention was those that I would see on PBS reruns when I was a kid.
00:38:47:10 - 00:39:00:11
Andy
And that was some of the original series from the seventies. So like that, you know, bad production, let's call it that production. It was bad production aside. It just was kind of magical. So that's that's what comes to mind for me.
00:39:00:13 - 00:39:18:24
Nick
Fair enough. I'm only a recent since the 2005 reboot fan myself. So on my list to potentially go back and check this out. Moving on, though, Andy, our next question, what's one personal recommendation for a good, healthy and happy life?
00:39:19:01 - 00:39:51:03
Andy
All right. So we're right around the new year and there's a lot of new Year. I'll frame it as New Year, New you. So resolution time. I don't love that framing. So the past you you know, the 2023, you was probably a pretty good person. You might be able to make yourself a little bit better in 2024, but my, my own personal approach to that is find the things that you love that are great about yourself and focus on those strengths.
00:39:51:03 - 00:40:11:21
Andy
So instead of framing the way that you think about yourself in the world of what are the things that I wish to leave behind or to cut out of my life or to cut out of myself, I would say that it's more of a good, healthy approach to focus on what am I good at and what can I do to augment those strengths or to really focus on those things.
00:40:11:22 - 00:40:29:21
Andy
It's just a more positive, it's a more optimistic framing, and that that's how I try to view things. We are naturally, as humans, very attuned to the things that are not good, things that are negative, things that are causing issues or pain, but focusing on what you're good at and what you like about yourself. It's work. For me.
00:40:29:23 - 00:40:49:06
Nick
It's a sentiment that I really love and shared this internally at Pixar, so I'm glad that you're able to share that message with others. I hope that other I hope it resonates with others. It's definitely something that I strive for myself and it's always good. As a reminder. Andy, this is our last of this series of questions, and it's probably my favorite one to ask guests that are on the show.
00:40:49:08 - 00:41:00:19
Nick
The question here for you is what reality TV show or game show, would you be most likely to win or would you just have the most fun appearing on?
00:41:00:21 - 00:41:18:19
Andy
I'd love to play me some Plinko, like Get Me On The Price Is Right, Baby. And I would love to play some Plinko like I Summers as a kid and coming back to like television as a kid again watching prices. Right? Reruns. Love it. Plinko was always the best.
00:41:18:21 - 00:41:37:20
Nick
I don't think this question in particular tells us anything about the guest and their personality or things like that. I just think it elicits an excitement because everybody has that one show that they would want to go on. And I think you were a great example of you had it right off the tip of your tongue. You are ready to go shows your true interest in it.
00:41:37:22 - 00:41:54:15
Nick
So Andy, with that, thank you for appearing on the show today. Before we go, final item here, and I think you mentioned this earlier, but just so that everybody knows at the end if folks have questions or if they want to find out more about the trend report or they've got ideas or suggestions, where can they contact you with those sort of items?
00:41:54:17 - 00:42:20:11
Andy
Yeah, please reach out to trend report at pharmacyquality.com. Those come directly to me and I love to see them. So if you have had really any thought about the trend report what you like what you don't like if you have read it and had any thoughts please reach out to me. I would love to get that feedback, especially about what has worked, what hasn't, or if you have things that you'd like us to look into.
00:42:20:13 - 00:42:36:07
Nick
Excellent for Andy again, thank you very much. We'll look forward to all of the in advance. We'll look forward to all the questions that you get about the trend report or the suggestions you get for the next trend report. But with that, we have wrapped up this episode of The Quality Corner Show. So for a listening audience, we thank you for joining us today.
00:42:36:13 - 00:42:41:18
Nick
I hope you listen to our next episode of, the show. Before we go, we have one final message from PQS.
00:42:41:18 - 00:43:04:06
Outro
The pharmacy quality solutions Quality Corner Show has a request. Our goal is to spread the word about how quality measurement can help improve health outcomes. And we need your help in sharing this podcast to friends and colleagues in the healthcare industry. We also want you to provide feedback, ask us questions and suggest health topics you'd like to see covered.
00:43:04:08 - 00:43:26:13
Outro
If you are a health expert and you want to contribute to the show or even talk on the show, please contact us. You can email info at pharmacy quality dot com. Let us know what is on your mind. What we can address so that you are fully informed. We want you to be able to provide the best care for your patients and members, and we wish all of you listeners out there well.