Pharmacy-specific quality indicators for asthma therapy

Lack of appropriate drug therapy in asthma patients is a recognized quality problem leading to preventable emergency room visits, hospitalizations, or death. While indicators measuring pharmacotherapy quality on the level of prescribers and third party payers are widely used, no such indicators exist for pharmacies.

This study aimed to (1) develop quality indicators for asthma care applicable to retail pharmacies, (2) estimate the prevalence of inappropriate asthma drug therapy, and (3) explore variation in the quality of care across pharmacies.

We present a descriptive analysis of automated patient-specific dispensing data from February 1, 2000 to January 31, 2001 of beta-agonists and anti-inflammatory agents with a Food and Drug Administration-approved indication for asthma. Two quality indicators of potentially inappropriate drug therapy were applied: (1) the proportion of patients who obtained more than a 360-day supply (assuming maximum acceptable daily dose) of short-term beta-agonists (SABA) including all inhaler types, inhaler solutions, and syrups during the 12-month study and (2) the proportion of patients with 2 consecutive early refills of defined SABAs. Indicator values with 95% confidence intervals are reported for each pharmacy.

Pharmacies had an average of 328 (range 169-534) patients who received SABAs. An average of 11 patients per pharmacy (3.4% of all patients who received SABAs) met the indicator 1 definition. The second indicator identified 8.2% (27) patients per pharmacy as short-term SABA overusers (range 3.9-11.9%). Of these, 48% did not receive any anti-inflammatory agents during the time frame when SABA overuse occurred.

Application of drug therapy quality indicators at the level of individual pharmacies using dispensing data is feasible and identifies opportunities for quality improvement. Indicator 2 is most appropriate for daily practice, because it allows for timely identification of potentially uncontrolled patients, and offers a balance between indicator sensitivity and positive predictive value.