Britnell Sara R, Brown Jamie N, Hashem Mohamed G, Hale Jonathan C, Bryan William E, Hammond Julie M, Britt Rachel B
Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, NC
Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, NC.
Am J Health Syst Pharm. 2018 Dec 1;75(23 Supplement 4):S87-S93. doi: 10.2146/ajhp170431. Epub 2018 Sep 18.
Results of a study to determine economic outcomes of pharmacy residents' involvement in prior-authorization drug request (PADR) adjudication within a Veterans Affairs (VA) healthcare system are reported.
A retrospective review was conducted to identify PADRs adjudicated by pharmacy residents under a preceptor's supervision during the 2015-16 residency year. Only PADRs that were not approved as submitted (i.e., only those requiring formulary intervention) and that met other inclusion criteria were included in the analysis. Prior-authorization requests and adjudication decisions were characterized, and cost savings resulting from those decisions were calculated.
Of the total of 752 PADRs adjudicated by 6 pharmacy residents during the study period, 42 met the inclusion criteria. About 90% of included PADRs were categorized as general medicine requests, and 9.5% were for oncology medications. The most common rationale for PADR nonapproval (cited in 60% of requests) was the availability of a preferred formulary alternative; the remainder of nonapprovals were due to medication safety concerns (e.g., contraindication to therapy, drug interaction potential, likelihood of adverse drug event resulting in patient harm, history of allergy to requested medication). Resident adjudication of PADRs resulted in total direct cost savings of $169,877.53 over the 12-month period, a mean of $4,044.70 per request.
Pharmacy residents' involvement in adjudicating PADRs at a VA healthcare system resulted in substantial cost savings over the course of the residency year.
报告一项关于确定药学住院医师参与退伍军人事务部（VA）医疗系统中预先授权药物申请（PADR）裁定的经济结果的研究结果。
进行回顾性审查，以确定2015 - 16学年住院医师在带教老师监督下裁定的PADR。仅纳入那些未按提交内容获批（即仅那些需要处方集干预）且符合其他纳入标准的PADR进行分析。对预先授权申请和裁定决定进行了特征描述，并计算了这些决定所带来的成本节约。
在研究期间，6名药学住院医师裁定的752份PADR中，有42份符合纳入标准。纳入的PADR中约90%被归类为普通内科申请，9.5%为肿瘤药物申请。PADR未获批的最常见理由（在60%的申请中被提及）是有首选的处方集替代药物；其余未获批是由于用药安全问题（例如，治疗禁忌、药物相互作用可能性、药物不良事件导致患者伤害的可能性、对所申请药物的过敏史）。住院医师对PADR的裁定在12个月期间总共节省了169,877.53美元的直接成本，每份申请平均节省4,044.70美元。
在VA医疗系统中，药学住院医师参与裁定PADR在住院医师学年期间带来了大量成本节约。
