QUALITY IMPROVEMENT

PROJECT

Lower Cost Medications

Monica Cenkowski and Parham Ahranjani

THE PROBLEM

• What: Medications are often an important part of a patient’s health, but can be expensive

• Why: High medication costs can lead to non-compliance and deterioration of health

• Where: Medication cost is a challenge in the outpatient setting, where drug coverage is not universal

• Who: Patients that are most impacted are those without drug coverage (seniors, vulnerable people, self-employed, etc)

• When: Drug costs have been a longstanding issue, which continues to affect patients

• How: Ultimately, patients who are unable to afford their medications may experience deterioration of their physical and mental health, which can lead to
a reduced quality of life. This can also cause strain on patient’s family members and their health care providers. The impact of this for everyone involved
is daily.

• In Summary:
The financial cost of medications can impact patients mental and physical health, but at times is not considered in initial prescribing resulting
in higher costs, lower medication compliance, negative impact on family life, as well as an increased burden on the healthcare system.
A I M S TAT E M E N T

•
In KMC patients who are taking ACE-inhibitors other than ramipril, 50% of those who
attend medication review visits will be engaged in discussion about switching to
ramipril for cost effectiveness by December 1st,  2023.
 B A S E L I N E D ATA
• Queries run on Oct 3/2022
• Office = ‘kildonan medical centre’
• Age older than 18 years
• Prescription contains ‘ramipril’ and prescription status = ‘active’ and prescription external = ‘false’
• 367 pts on Ramipril
• Office = ‘kildonan medical centre’
• Age older than 18 years
• Prescription contains ‘ramipril’ or ‘cilazapril’ or ‘enalapril’ or ‘fosinopril’ or ‘lisinopril’ or ‘perindopril’ and prescription
status = ‘active’ and prescription external = ‘false’
• 452 pts who are on non-ramipril Ace-inhibitors

•
452 pts on ACEIs – 367 pts already on ramipril = 85 pts who could potentially switch
FISH BONE DIAGRAM
CHANGE IDEAS
HTN MACRO

Macro to be used for all

medication review visits,
HTN specific visits and
PHVs
NEXT STEPS: PDSA CYCLES #1,2,3

• PDSA #1

• Goal: To apply the “HTNvisit” macro to help patients who are using Ace inhibitors to use the
lowest cost version of Ace-inhibitors

• Who: Monica + Parham

• When: June 2023 in clinic with a patient that arrives for a HTN visit

• PDSA #2

• To include all residents trialing the macro in August 2023. Followed by informal resident feedback

• PDSA #3

• To include all attendings at KMC to trial the macro in Sept 2023. Followed by informal feedback