Evaluating regional and temporal variations in quality indicators for opioid initiation and pharmacist medication reviews in Ontario: A population-based repeated cross-sectional study

Background: Quality indicators (QIs) are measures used to evaluate quality of services but are often underused in pharmacy practice. This study examines trends in 2 established QIs in community pharmacy. Methods: We conducted a repeated cross-sectional study in Ontario using administrative data collected between 2013 and 2023. We measured 2 QIs designed for pharmacy practice annually: (1) percentage of newly dispensed opioid prescriptions exceeding 50 morphine milligram equivalents (MME), and (2) percentage of eligible patients receiving pharmacist medication reviews within 7 days of hospital discharge. Regional differences were summarized using variance calculations, while temporal trends were analyzed using Mann-Kendall tests. Results: The opioid indicator demonstrated a consistent decline in the percentage of newly dispensed opioid prescriptions exceeding 50 MME across Ontario, with an absolute reduction of 10.5% from 2013 (25.6%) to 2023 (15.1%). High-dose opioid initiation ranged from 12.8% (Central) to 16.7% (West) in 2023 (range 3.9%, variance 2.3%). Significant time trends were found for all regions, with the largest reductions observed in urban regions. For the medication review indicator, provincial trends declined by 7.6%, from 16.7% in 2013 to 9.1% in 2017, followed by a modest recovery to 12.5% by 2023. Regionally, rates of medication reviews varied, with rural areas maintaining higher uptake rates compared with urban centres. Rates ranged from 7.8% (Toronto) to 16.2% (North) in 2023 (range 8.4%, variance 10.0%). A significant time trend was found only in Eastern Ontario. Conclusion: Significant declines in high-dose opioid initiation but inconsistent uptake of reviews across regions indicate opportunities for improvement in pharmacy practice.