Influence of prior authorization requirements on provider clinical decision-making.
Influence of prior authorization requirements on provider clinical decision-making.
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DOI：
10.37765/ajmc.2023.89394
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发表时间：
2023-07
期刊：
影响因子：
--
通讯作者：
McAdam-Marx C
中科院分区：
文献类型：
--
作者：
Salzbrenner SG;Lydiatt M;Helding B;Scheier LM;Greene H;Hill PW;McAdam-Marx C
事先授权（PA）旨在促进药物的安全有效使用并控制成本。然而，pa相关的管理任务可能会增加卫生保健提供者的负担。本研究考察了这些任务如何影响治疗决策。横断面在线调查。我们在2020年对美国医疗服务提供者进行了一项基于10万名提供者的便利样本的在线调查。多变量路径分析用于检查提供者实践特征、步骤治疗和其他健康计划要求、感知PA负担、与保险公司的沟通问题和处方行为（与计划不同的药物处方、即使符合循证指南建议也避免开新药物处方、修改诊断）之间的关联。进行加权分析以评估无反应偏倚。共有1173名受访者（1.2%的回复率）提供了1147份可用调查。分步治疗要求对临床决策影响最大。对临床决策的其他显著影响包括感知PA可能性、沟通问题和健康计划要求（如临床文件）。加权分析表明，研究结论不太可能因无反应而产生偏差。受访者报告说，他们可能会改变临床决定，以避免PA要求和相关负担，即使在临床上使用PA药物是适当的情况下。通过改善沟通和透明度以及标准化文件来减轻医管局管理负担的流程可能有助于确保医管局更无缝地实现其安全有效使用药物的目标。
Prior authorization (PA) aims to promote the safe and effective use of medications and to control costs. However, PA-related administrative tasks can contribute to burden on health care providers. This study examines how such tasks affect treatment decisions. Cross-sectional, online survey. We conducted an online survey of US medical providers in 2020 based on a convenience sample of 100,000 providers. Multivariate path analysis was used to examine associations among provider practice characteristics, step therapy and other health plan requirements, perceived burdens of PA, communication issues with insurers, and prescribing behaviors (prescribing a different medication than planned, avoiding prescribing of newer medications even if evidence-based guideline recommendations are met, and modifying a diagnosis). Weighted analyses were conducted to assess nonresponse bias. A total of 1173 respondents (1.2% response rate) provided 1147 usable surveys. Step therapy requirements had the largest effect on clinical decision-making. Other significant effects on clinical decision-making included perceived PA likelihood, communication issues, and health plan requirements (eg, clinical documentation). Weighted analyses showed that the study conclusions were unlikely to have been biased by nonresponse. Respondents report that they may alter clinical decisions to avoid PA requirements and related burdens, even in cases in which use of the PA medication was clinically appropriate. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications.
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DOI：
10.1080/10705519909540118
发表时间：
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影响因子：
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