Clinical and Cost-Effectiveness of Meds Check in Ontario Seniors: A Mixed-Methods Study

Purpose

In April 2007, Ontario has launched the MedsCheck Annual program – a medication review led by community pharmacists for patients taking at least three prescription medications for a chronic condition. The overall aim of this study is to evaluate the effectiveness and cost-effectiveness of this program in Ontario.

Research Question

The study has five sub-projects where 1-3 are collaborative projects between THETA and The Ontario Pharmacy Research Collaboration (OPEN) research groups. The specific objectives of each project are:

    Project 1: Describe the users of MedsCheck Annual (MCA) services in Ontario from 2007-2013 and the service uptake.

    Project 2: Evaluate patient, pharmacy and community-level factors that affect the likelihood of receiving an MCA in     Ontario.

    Project 3: Evaluate the effectiveness of the MCA program in Ontario seniors.

    Project 4: Evaluate the cost-effectiveness of the MCA program in Ontario seniors.

    Project 5: Explore the ‘real world’ context of MedsCheck reviews and the experiences of providers (i.e. pharmacists,     trainees, technicians) and patients.
 

Inclusion Criteria (varies by project)

• Patient-pharmacy encounters of all Ontario patients above 65 years old who were eligible to receive an MCA review at pharmacy visits anytime between April 1, 2008 and March 31, 2013 will be included.

• MedsCheck (intervention) cohort will include all Ontario patients above 65 years old who had their first MCA review conducted anytime between April 1, 2008 and March 31, 2010 (study accrual period).

• We will employ purposive sampling to select four pharmacies that vary in type (chain/banner; independent) and location (smaller more intimate community setting; larger more anonymous urban setting).

Exclusion Criteria (varies by project)

• All other patient-pharmacy encounters during the selected time period when the patient was on less than three chronic medications will be excluded.

• All other patients in the Ontario Drug Benefit (ODB) database during the study accrual period that were not eligible to receive MCA review by the study’s established criteria will be excluded.

• Patients who receive MedsCheck Annual Diabetes or Home reviews are no not eligible for MCA.

Design and Methods

The study will utilize a mixed-methods design by combining quantitative (Projects 1-4) and qualitative (Project 5) research methods. Projects 1-4 will use linked administrative databases at the Institute for Clinical Evaluative Sciences (ICES). Project 5 will utilize ethnographic observations, ethnographic interviews and in-depth semi-structured interviews in four pharmacy sites.

Study Timeline

September 2013 – June 2016

Research Team

THETA Team:
Murray Krahn, MD, MSc, FRCPC
Valeria Rac, MD, PhD
Lusine Abrahamyan, MD, MPH, PhD (Project Lead)
Petros Pechlivanoglou, PhD
Fiona A. Miller, MA, PhD
Sarah Jessica Patton, MA
Susanne Priest, MScPhm MBA
Nicholas Mitsakakis, MSc, PhD
Suzanne Chung, BEd, CCRP
James Bowen, BScPhm MSc
Paul Grootendorst, PhD
Job van Boven, PharmD MSc
Mohammed Mahdi, BScPhm PharmD

OPEN Team:
Linda D. MacKeigan, BSc, Phm, PhD (lead)
Lisa Dolovich, BScPhm, PharmD, MSc (co-lead)
Nedzad Pojskic, HonBSc, MSc, PhD
Suzanne Cadarette, BSc, MSc, PhD
Andrea Burden, BSc, MA, PhD
Giulia Consiglio, BSc, MSc
Lori MacCallum, BScPhm, PharmD
Elizabeth Bojarski, BA, MPH

Funding

Blueprint for Pharmacy