Medication prior authorization in pediatric hematology and oncology
Medication prior authorization in pediatric hematology and oncology
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DOI：
10.1002/pbc.26339
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发表时间：
2017-06-01
影响因子：
3.2
通讯作者：
Pollock, Brad H.
中科院分区：
文献类型：
--
作者：
Dickens, David S.;Pollock, Brad H.
背景：药物事先授权 (PA) 是一项常见的要求，特别是对于用于罕见疾病的药物。根据标准定义，影响儿童的癌症和许多血液疾病都很罕见。该研究的目的是描述 PA 请求的相对频率及其与付款人和药物的关联，以确定提高系统效率的机会。程序：前瞻性记录 7 个月内在单一机构就诊的患者的药物 PA 请求。经期流行率用于估计 PA 请求的相对频率。描述性统计总结了付款人、药物和批准与 PA 请求频率相关的关系。结果：在 150 个临床日的研究期间，有 5,583 名患者就诊。总共收到 142 份药物 PA 请求，导致患者就诊期间患病率为 2.5%。在具有可用结果数据的 137 项药物 PA 请求中，135 项 (98.5%) 经过提供者的额外努力最终获得批准。诊所工作人员每次请求花费的时间中位数为 46 分钟，四分位数范围为 25-80 分钟。不同付款人之间存在显着的流程异质性。结论：儿科血液学和肿瘤学 (PHO) 中的药物 PA 请求实际上不会导致护理的改变。 PHO 中的药物利用管理策略未能提供其他医学领域报道的益处，并且对护理的及时性和肠外心理/情绪健康产生无法衡量的负面影响。通过付款人和提供者合作为 PHO 患者制定处方标准，有机会提高效率。
Background: Medication prior authorization (PA) is a commonly occurring requirement, particularly for medications used for rare conditions. Based on standard definitions, cancer and many blood disorders affecting children are rare. The study aims were to describe the relative frequency of PA requests and their association with payers and medications in order to identify opportunities to improve system efficiency.Procedure: Requests for medication PA were logged prospectively for patients seen at a single institution over a 7-month period. Period prevalence was used to estimate the relative frequency of PA requests. Descriptive statistics summarized the relationship among payers, medications, and approvals relative to the frequency of PA requests.Results: For the study duration of 150 clinic days, there were 5,583 patient visits. A total of 142 medication PA requests were received resulting in a period prevalence rate of 2.5% patient visits. Of the 137 medication PA requests with available outcome data, 135 (98.5%) were ultimately approved with additional provider efforts. The median clinic staff time spent per request was 46 min with an interquartile range of 25-80 min. There was striking process heterogeneity among different payers.Conclusion: Virtually no medication PA request in pediatric hematology and oncology (PHO) leads to alterations in care. Medication utilization management strategies in PHO fail to provide benefits reported in other areas of medicine and have unmeasured negative effects on timeliness of care and parenteral psychological/emotional health. There is opportunity for increasing efficiency through payer and provider collaboration on the creation of prescribing standards for PHO patients.