Glassman Peter A, Good Chester B, Kelley Mary E, Bradley Melissa, Valentino Michael
Department of Veterans Affairs Greater Los Angeles Healthcare System and the David Geffen School of Medicine, University of California, Los Angeles 90073, USA.
Am J Manag Care. 2004 Mar;10(3):209-16.
To assess physician satisfaction with Department of Veterans Affairs (VA) formulary policies and to examine the correlation between physician satisfaction and perceived access to formulary and nonformulary medications.
Cross-sectional survey with specific questions on access to formulary and nonformulary medications. Statistical analyses included assessment of associations between physician satisfaction and various measures of access.
Initial sample of 4015 staff physicians working in VA healthcare facilities. Responses were received from 1812 (49%) of the 3682 physicians in the final eligible sample population.
Most clinicians (72%) reported that their local formulary covered more than 90% of the medications they wanted to prescribe. Most (73%) agreed that drug restrictions were important to contain costs, and 86% agreed that it was important for VA to choose "best-value" drugs. Respondents reported an 89% approval rate for nonformulary drugs, though 31% indicated that approvals routinely took 3 or more days. We found strong associations between physician satisfaction and self-reported approval rates for nonformulary drugs (P = .001), timely approval of nonformulary requests (P < .001), and percentage of nonformulary prescriptions as a proportion of overall prescriptions at a regional level (P< .01). There was no significant correlation between physician satisfaction and number of medications added to regional formularies or with drug costs per unique patient.
VA physicians were generally supportive of VA formulary policies including choosing best-value drugs to control pharmaceutical expenditures. Nevertheless, access to nonformulary drugs and timely approval of requests for nonformulary medications were strong predictors of clinician satisfaction and support for cost-containment measures.
评估医生对退伍军人事务部（VA）药品目录政策的满意度，并考察医生满意度与获取处方和非处方药物的感知之间的相关性。
横断面调查，包含关于获取处方和非处方药物的特定问题。统计分析包括评估医生满意度与各种获取措施之间的关联。
最初样本为在VA医疗设施工作的4015名 staff physicians（此处“staff physicians”不太明确准确含义，可能是“在职医生”之类）。最终符合条件的样本群体中有3682名医生，收到了其中1812名（49%）的回复。
大多数临床医生（72%）报告称，他们当地的药品目录涵盖了他们想要开具的90%以上的药物。大多数人（73%）同意药物限制对于控制成本很重要，86%的人同意VA选择“最具性价比”的药物很重要。受访者报告非处方药物的批准率为89%，不过31%的人表示批准通常需要3天或更长时间。我们发现医生满意度与非处方药物的自我报告批准率（P = .001）、非处方申请的及时批准（P < .001）以及地区层面非处方处方占总处方的比例（P < .01）之间存在很强的关联。医生满意度与添加到地区药品目录中的药物数量或每位患者的药物成本之间没有显著相关性。
VA医生总体上支持VA药品目录政策，包括选择最具性价比的药物以控制药品支出。然而，获取非处方药物以及非处方药物申请的及时批准是临床医生满意度和对成本控制措施支持的有力预测因素。
