AUTHOR=Morris Katherine , Spittal Matthew J. 

TITLE=Grading pharmacists’ risk of complaints to a regulator: A retrospective cohort study

JOURNAL=Journal of Pharmacy & Pharmaceutical Sciences

VOLUME=Volume 26 - 2023

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/journal-of-pharmacy-pharmaceutical-sciences/articles/10.3389/jpps.2023.11228

DOI=10.3389/jpps.2023.11228

ISSN=1482-1826

ABSTRACT=Background
Tools to grade risk of complaint to a regulatory board have been developed for physicians but not for other health practitioner groups, including pharmacists. We aimed to develop a score that classified pharmacists into low, medium and high risk categories.

Method
Registration and complaint data were sourced from Ontario College of Pharmacists for January 2009 to December 2019. We undertook recurrent event survival analysis to predict lodgement of a complaint. We identified those variables that were associated with a complaint and included these in a risk score which we called PRONE-Pharm (Predicted Risk of New Event for Pharmacists). We assessed diagnostic accuracy and used this to identify thresholds that defined low, medium and high risk. 

Results 
We identified 3,675 complaints against 17,308 pharmacists. Being male (HR = 1.66), older age (HR range 1.43 to 1.54), trained internationally (HR = 1.62), ≥1 prior complaint (HR range 2.83 to 9.60), and complaints about mental health or substance use (HR = 1.90), compliance with conditions (HR = 1.86), fees and servicing (HR = 1.74), interpersonal behaviour or honesty (HR = 1.40), procedures (HR = 1.75) and treatment or communication or other clinical issues (HR = 1.22) were all associated with lodgement of a complaint. When converted into the PRONE-Pharm risk score, pharmacists were assigned between 0 and 98 points with higher scores closely associated with higher probability of a complaint. A score of ≥25 had sufficient accuracy for classifying medium-risk pharmacists (specificity = 87.0%) and ≥45 for high-risk pharmacists (specificity = 98.4%).

Conclusions
Distinguishing isolated incidents from persistent problems poses a significant challenge for entities responsible for the regulation of pharmacists and other health practitioners. The diagnostic properties of PRONE-Pharm (minimizing the false positives) means that the risk score is useful for “ruling-out” low risk pharmacists using routinely collected regulatory data. PRONE-Pharm may be useful when used alongside interventions appropriately matched to a pharmacist’s level of risk.