Perceptions of prior authorization by use of electronic prior authorization software: A survey of providers in the United States.
Perceptions of prior authorization by use of electronic prior authorization software: A survey of providers in the United States.
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DOI：
10.18553/jmcp.2022.28.10.1121
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发表时间：
2022-10
影响因子：
2.1
通讯作者：
Hill, Patricia Wonch
中科院分区：
文献类型：
--
作者：
Salzbrenner, Stephen G.;McAdam-Marx, Carrie;Lydiatt, Maxwell;Helding, Brandon;Scheier, Lawrence M.;Hill, Patricia Wonch
考虑到提供者、患者和健康计划的管理负担，人们一致认为药物事先授权 (PA) 流程需要简化和标准化。这包括更广泛地采用电子 PA (ePA) 解决方案，包括实时临床效益确定。深入了解提供商在 ePA 方面的经验将有助于健康计划和药品福利管理者 (PBM) 确定 PA 流程改进方面的工作和投资的优先顺序。通过在美国的全国供应商样本中使用 ePA 技术来确定供应商的 PA 体验。 2020 年，向获得许可的提供商发送了一项全国范围的在线调查。该调查获取了有关提供商的 PA 体验的信息，包括 PA 工作量、沟通 PA 决策的时间以及与计划/PBM 进行的其他与 PA 相关的互动。使用基于序数量表的项目方差检验分析和名义变量的卡方检验统计量，比较了提供者特征和提供者使用 ePA 的调查响应。多变量回归分析确定了 ePA 使用与 PA 体验变量之间的关联，并控制了提供者的特征。在提交可用调查的 1,147 家提供商中，58% 的受访者表示至少在部分 PA 提交中亲自使用了 ePA，88% 的受访者每周至少提交 1 份 PA，大多数 (82%) 每周在 PA 提交上花费最多 5 个小时。大多数人 (58.5%) 表示经常需要手动 PA。与不使用 ePA 软件的提供商相比，使用 ePA 的提供商提交的 PA 数量更高 (P < 0.001)，并且在 PA 提交上花费的时间更多 (P = 0.003)，但 PA 提交从开始到结束的持续时间没有差异 (P = 0.211)。使用 ePA 的提供者报告说，确定分步治疗要求更加困难 (P = 0.005)，并且更频繁地需要提交额外文件 (P = 0.022)。 PA 相关的通信故障没有差异。使用 ePA 的人报告 PA 决策的时间比不使用 ePA 的人更短 (P = 0.004)。单变量描述性研究结果得到多变量分析的支持。这项大型全国性调查发现，提供商使用 ePA 与提供商在准备和提交 PA 请求方面的时间减少或挑战减少无关。然而，据报道，使用 ePA 会缩短 PA 决策时间。标准化 PA 要求、支持实时福利检查功能以及将 ePA 流程更好地集成到提供商工作流程中的努力可能有助于减少 PA 负担和治疗延误。健康计划必须先批准某些药物的使用，然后才能承保这些药物。这项研究调查了医生和其他处方医疗保健提供者的审批流程。研究发现，使用软件请求批准的提供者通常不会发现该过程更快或更容易，但健康计划可能需要更短的时间才能做出决定。需要改进流程和软件，以减少医生花在请求上的时间。
Given provider, patient, and health plan administrative burden, there is consensus that the medication prior authorization (PA) process needs to be streamlined and standardized. This includes broader adoption of electronic PA (ePA) solutions, including real-time clinical benefit determination. Insight into provider experiences with ePA will help health plans and pharmacy benefit managers (PBMs) prioritize efforts and investments in PA process improvement. To identify provider experiences with PA by their use of ePA technology in a national sample of providers from the United States. An online, nationwide survey was sent to licensed providers in 2020. The survey obtained information on provider experiences with PA, including PA workload, time to the communication of a PA decision, and other PA-related interactions with plans/PBMs. Provider characteristics and survey responses by provider use of ePA were compared using analysis of variance tests for items based on ordinal scales and a chi-square test statistic for nominal variables. Multivariable regression analyses identified associations between ePA use and PA experience variables, controlling for provider characteristics. Of 1,147 providers submitting usable surveys, 58% reported personally using ePA for at least some of their PA submissions, 88% submit at least 1 PA in a typical week, and most (82%) spend up to 5 hours a week on PA submissions. A majority (58.5%) reported that manual PA is often required. Those using ePA submitted a higher volume of PAs (P < 0.001) and spent more time on PA submissions (P = 0.003) than providers not using ePA software, but the duration of time from start to finish for a PA submission did not differ (P = 0.211). Providers who use ePA reported more difficulty identifying step therapy requirements (P = 0.005) and more frequently needing to submit additional documentation (P = 0.022). PA-related communication failures did not differ. Those using ePA reported a shorter time to PA decision (P = 0.004) than those not using ePA. Univariate descriptive findings were supported by multivariable analyses. This large, nationwide survey identified that a provider’s use of ePA was not associated with less provider time or fewer challenges in preparing and submitting PA requests. However, the use of ePA was associated with a reported shorter PA decision time. Efforts to standardize PA requirements, support of real-time benefits check functionality, and better integration of ePA processes into provider workflows may help reduce PA burden and treatment delays. Health plans must approve the use of some drugs before they will cover those drugs. This study surveyed doctors and other prescribing health care providers on this approval process. It found that providers who use software to ask for approval generally do not find the process quicker or easier, but health plans may take less time to reach a decision. Improvements are needed in the process and software to reduce the time doctors spend on requests.
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影响因子：
2.1
作者：
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通讯作者：
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影响因子：
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作者：
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DOI：
10.1016/j.japh.2020.01.012
发表时间：
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作者：
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通讯作者：
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影响因子：
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作者：
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