Traditional data sources for identifying and resolving medication non-adherence in ambulatory settings (e.g., community pharmacies) include prescription fill histories and prescription claims data. However, these data sources have limitations. Patient-reported outcomes (PROs) offer a rich data source for pharmacists and prescribers to use to resolve medication non-adherence. To our knowledge, no examples of widespread electronic collection of PROs data pertaining specifically to medication adherence in ambulatory settings exist. PatientToc? is a PROs collection software developed by investigators from the L.A. Net Community Health Resources Network, a primary care practice-based research network in California. The software facilitates the collection of PROs data using Android devices, with audio assist in 200 languages available. Currently, it is being used in 36 primary care practices. While PatientToc? has been used successfully in primary care, the strategies needed to spread this or similar technology to community pharmacy settings is unknown.
The specific aims of the proposed project are to:
Aim 1 - Conduct a pre-implementation developmental formative evaluation to determine community pharmacy workflow and current practices for identifying and resolving medication non-adherence, potential barriers and facilitators to PatientToc? implementation, and create a draft implementation toolkit.
For Aim 1, we are partnering with PatientToc?, L.A. Net, and pharmacies in Indiana, Minnesota, and Wisconsin;
Aim 2 - Conduct two plan-do-study-act cycles to refine an implementation toolkit for spreading and scaling implementation of PatientToc? in community pharmacies. We will implement PatientToc? at 2-3 locations in each state. The toolkit will detail the intervention, including implementation strategies;
Aim 3 - Conduct a comprehensive, theory-driven evaluation of the quality of care, implementation, and patient health outcomes of spreading and scaling PatientToc? to community pharmacies.
For Aim 3, we will scale PatientToc? to 6-10 locations per state and engage our partners in a rigorous mixed-methods evaluation of PatientToc? implementation using interviews, observations, and administrative data. Collectively, our findings will inform long-term collection of PROs data pertaining to medication adherence in a novel ambulatory setting (community pharmacies) by spreading and scaling a successful model (PatientToc?) for health information technology-enabled PROs collection.
The proposed research is relevant to public health because the thoughtful, systematic spreading and scaling of a successful model for health information technology-enabled patient-reported outcomes data collection from primary care settings to community pharmacies is expected to result in improved outcomes for the chronically ill as well as improved Health People 2020 and Medicare Part D Plan star metrics. This work is relevant to AHRQ?s mission and focuses on AHRQ?s priority populations of the elderly and chronically ill.
