Understanding the medication prior-authorization process: A case study of patients and clinical staff from a large rural integrated health delivery system
Understanding the medication prior-authorization process: A case study of patients and clinical staff from a large rural integrated health delivery system
复制标题
DOI：
10.1093/ajhp/zxy083
复制
发表时间：
2019-04-01
影响因子：
2.7
通讯作者：
Gionfriddo, Michael R.
中科院分区：
文献类型：
--
作者：
Jones, Laney K.;Ladd, Ilene G.;Gionfriddo, Michael R.
目的.对综合卫生系统中当前优先授权（PA）过程的障碍和解决方案进行了评估。焦点小组进行了与患者在一个综合的卫生系统谁也有保险，从附属的健康计划和至少一个拒绝在过去一年的药物。与医务人员（医生，办公室工作人员和PA专家）进行半结构化访谈。焦点小组和访谈都进行了录音和转录。归纳分析被用来编码转录本和开发主题。三个焦点小组进行了13例患者，9名医务人员（3名医生，2名办公室工作人员，4名PA工作人员）谁与PA过程中的互动采访。会议确定了若干主题，包括巴勒斯坦权力机构进程的复杂性、所经历的后果以及关键利益攸关方之间的沟通不力。一个贯穿各领域的主题是，利益攸关方在整个巴勒斯坦权力机构进程中表达了沮丧、焦虑和愤怒的情绪。所有利益相关者都提出了如何改进这一过程以更好地促进他们的偏好的见解，例如获得需要PA的药物列表以及需要患者律师。这项研究的结果显示，PA过程是令人沮丧的，心烦意乱，并在这个过程中涉及的病人和医务人员的困扰。所确定的三个主题包括：巴勒斯坦权力机构进程的复杂性、巴勒斯坦权力机构进程所产生的后果以及利益攸关方之间的沟通不力。
Purpose. The barriers and solutions to the current prior-authorization (PA) process at an integrated health system were evaluated.Methods. Focus groups were conducted with patients at an integrated health system who also had insurance from an affiliated health plan and at least 1 denial for a medication in the past year. Semistructured interviews were conducted with medical staff (physicians, office staff, and PA experts). Both focus groups and interviews were audio-recorded and transcribed. Inductive analysis was used to code transcripts and develop themes.Results. Three focus groups were conducted with 13 patients, and 9 medical staff (3 staff physicians, 2 office staff, and 4 PA staff) who have interactions with the PA process interviewed. Several themes were identified including the complexity of the PA process, consequences experienced, and ineffective communication between key stakeholders. A cross-cutting theme was that stakeholders expressed feelings of frustration, anxiety, and anger throughout the PA process. All stakeholders offered insights on how the process could be improved to better facilitate their preferences, such as access to the list of medications that require PA and the need for a patient advocate.Conclusion. Results of this study revealed that the PA process was frustrating, upsetting, and infuriating to patients and medical staff involved in the process. Three main themes identified included the complexity of the PA process, consequences experienced from the PA process, and ineffective communication between stakeholders.