医疗机构药学干预对预先授权成功率和效率的影响。
Impact of Pharmacy Intervention on Prior Authorization Success and Efficiency at a University Medical Center.
机构信息
1 University of California San Francisco School of Pharmacy, San Francisco, California.
3 Center for Healthcare Policy and Research, University of California Davis, Sacramento, California.
出版信息
J Manag Care Spec Pharm. 2016 Oct;22(10):1167-71. doi: 10.18553/jmcp.2016.22.10.1167.
BACKGROUND
Prior authorizations (PAs) may improve appropriate use of prescription medications. Despite potential savings for health insurance plans, the PA process is time consuming for the ordering provider, pharmacy, and patient. The UC Davis Health System (UCDHS) has created a centralized pharmacy-run clinic PA process.
OBJECTIVE
To compare the mean PA processing time between the new centralized clinic and usual care and provide secondary endpoints for PA approval rates, time to prescription fill, time to prescription pick-up, total staff time, and estimated labor costs.
METHODS
This is a prospective observational study comparing sequential PA requests at the UCDHS centralized clinic (intervention) and other UCDHS clinics (usual care) between January 1, 2014, and December 31, 2014. The Cochran-Mantel-Haenszel test was used to compare dichotomous outcomes (approval/denial rates) between the 2 groups, controlling for insurance type. A generalized linear model was applied for comparing the continuous outcomes (PA process time, time to first fill, time to pick-up, and cost) with insurance type as covariate.
RESULTS
For the intervention group, 47 PAs were evaluated, and 77 PAs were evaluated in the usual care group. The average PA process time was 0.53 days for the intervention group versus 7.02 days for usual care (P < 0.001), and the PA approval rate was 93% for the intervention group versus 68% for usual care (P < 0.002). The mean time to fill was 2.49 days and 5.52 days for the intervention and usual care clinics, respectively (P = 0.02). The pick-up percentage was 75% versus 52% for intervention and usual care, respectively (P < 0.001). The intervention clinic spent a significantly lower mean time processing PAs (15 minutes vs. 64 minutes) compared with the usual care clinics (P < 0.001). It is estimated that the mean total labor cost per PA at the intervention clinic was $11.50 compared with $37.50 for the usual care clinics (P < 0.001).
CONCLUSIONS
Pharmacy-led interventions in PA processing resulted in a statistically significant benefit in improving time to PA approval, time to first fill, and time to pick-up.
DISCLOSURES
No outside funding supported this study. The authors report no conflicting interests. Melnikow and Cutler contributed the study concept and design, with assistance from the other authors. Lester, Barca, and She collected the data, and Xin performed all statistical analysis. Cutler was the major contributor to manuscript preparation, with assistance from the other authors.
背景
事先授权 (PA) 可改善处方药物的合理使用。尽管这可能为健康保险计划节省费用，但对于开处方的医生、药剂师和患者来说，这一过程十分耗时。加州大学戴维斯分校健康系统 (UCDHS) 创建了一个集中管理的药房运行的诊所 PA 流程。
目的
比较新的集中式诊所和常规护理的平均 PA 处理时间，并提供 PA 批准率、处方配药时间、处方取药时间、总员工时间和估计劳动力成本的次要终点。
方法
这是一项前瞻性观察性研究，比较了 2014 年 1 月 1 日至 2014 年 12 月 31 日期间，UCDHS 集中式诊所（干预组）和其他 UCDHS 诊所（常规护理组）的连续 PA 请求。采用 Cochran-Mantel-Haenszel 检验比较两组之间的二分类结局（批准/拒绝率），控制保险类型。采用广义线性模型比较连续结局（PA 处理时间、首次配药时间、取药时间和成本），并以保险类型为协变量。
结果
干预组评估了 47 份 PA，常规护理组评估了 77 份 PA。干预组的平均 PA 处理时间为 0.53 天，而常规护理组为 7.02 天（P < 0.001），干预组的 PA 批准率为 93%，而常规护理组为 68%（P < 0.002）。干预组和常规护理组的平均配药时间分别为 2.49 天和 5.52 天（P = 0.02）。干预组的取药比例为 75%，常规护理组为 52%（P < 0.001）。与常规护理诊所相比，干预诊所处理 PA 的平均时间显著减少（15 分钟与 64 分钟）（P < 0.001）。干预诊所每份 PA 的平均总劳动力成本估计为 11.50 美元，而常规护理诊所为 37.50 美元（P < 0.001）。
结论
PA 处理过程中的药房主导干预措施在改善 PA 批准时间、首次配药时间和取药时间方面具有统计学意义。
披露
本研究无外部资金支持。作者报告没有利益冲突。Melnikow 和 Cutler 对研究概念和设计做出了贡献，其他作者也提供了帮助。Lester、Barca 和 She 收集了数据，Xin 进行了所有的统计分析。Cutler 主要负责准备手稿，其他作者也提供了帮助。
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