Medication prior authorization from the providers perspective: A prospective observational study
Medication prior authorization from the providers perspective: A prospective observational study
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DOI：
10.1016/j.sapharm.2018.09.019
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发表时间：
2019-09-01
影响因子：
3.9
通讯作者：
Warholak, Terri L.
中科院分区：
文献类型：
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作者：
Bhattacharjee, Sandipan;Murcko, Anita C.;Warholak, Terri L.
背景：社区提供者使用的药物的事先授权 (PA) 流程需要现代化。因此，从社区提供者的角度更深入地了解 PA 的现状对于为管理式医疗工具提供信息和使其现代化至关重要。 目的：本研究的目的是从提供者实践的角度识别、分析和分类与药物 PA 流程相关的问题。方法：使用半结构化访谈和直接观察对美国亚利桑那州图森市的八个初级保健和医学亚专科小组实践的方便样本进行了一项前瞻性非实验性、横断面、观察性研究。参与实践需要有既定的药物 PA 流程。使用 Richards 定性编码技术对每个站点的参与者反馈进行了分析，该技术包括描述性编码、主题编码和分析性编码。 结果：数据从 8 个独特的社区提供者办公室（8 个站点）获得，其中有 29 名处方者执业。确定的痛点分为五个主要类别：1）信息传输差距； 2）格式差异； 3）技术落后； 4）护理后果； 5) 解决方法。处方医生及其工作人员提出了改进建议，包括电子处方过程中有关 PA 的实时资格和处方警报、准确、最新的处方数据以及易于访问的替代方案，以及与电子病历数据集成的嵌入式 PA。三个站点使用 CoverMyMeds (R) 等药物 PA 门户进行信息收集，但在数据收集时，没有站点使用这些 PA 门户进行预期电子事先授权 (ePA) 或向健康计划付款人请求承保授权的电子流程。结论：社区提供者使用的药物 PA 流程迫切需要现代化。本研究中发现的痛点可以通过实施药物 ePA 解决方案来缓解。然而，提供商及其员工基本上不知道 ePA 的存在。该领域需要进行更多研究。
Background: The prior authorization (PA) process for medications used by community providers requires modernization. Therefore, a deeper understanding of current state of PA from the community provider perspective is imperative to inform and modernize this managed care tool.Objectives: Objectives of this study were to identify, analyze and categorize the issues associated with the medication PA process from provider practice perspective.Methods: A prospective non-experimental, cross sectional, observational study was performed using semi-structured interviews and direct observation at a convenience sample of eight primary care and medicine subspecialty group practices in Tucson, Arizona, USA. Participating practices were required to have an established medication PA process. The participant feedback from each site was analyzed using the Richards qualitative coding technique that includes descriptive coding, topic coding, and analytical coding.Results: Data were obtained from eight unique community provider offices (8 sites) at which 29 prescribers practice. The pain points identified represented five main categories: 1) information transfer gaps; 2) format disparities; 3) outdated technologies; 4) care consequences; and 5) workarounds. Prescribers and their staff suggested improvements that included real time eligibility and formulary alerts regarding PA during the e-prescribing process, accurate, up-to-date formulary data with easy-to-access alternatives, and embedded PA that is integrated with electronic medical record data. Three sites used medication PA portals such as CoverMyMeds (R) for information gathering, but at the time of data collection, no sites used these PA portals for prospective electronic prior authorization (ePA) or the electronic process of requesting authorization from health plan payers for coverage.Conclusion: The PA process for medication used by community providers is in urgent need of modernization. Pain points identified in this study could be alleviated by implementing medication ePA solutions. However, providers and their staff are largely unaware that ePA exists. Additional research in this area is needed.