Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA; Department of Biomedical Informatics, College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Cambiare LLC, Phoenix, AZ, USA.
Res Social Adm Pharm. 2019 Sep;15(9):1138-1144. doi: 10.1016/j.sapharm.2018.09.019. Epub 2018 Sep 26.
The prior authorization (PA) process for medications used by community providers requires modernization. Therefore, a deeper understanding of current state of PA from the community provider perspective is imperative to inform and modernize this managed care tool.
Objectives of this study were to identify, analyze and categorize the issues associated with the medication PA process from provider practice perspective.
A prospective non-experimental, cross sectional, observational study was performed using semi-structured interviews and direct observation at a convenience sample of eight primary care and medicine subspecialty group practices in Tucson, Arizona, USA. Participating practices were required to have an established medication PA process. The participant feedback from each site was analyzed using the Richards qualitative coding technique that includes descriptive coding, topic coding, and analytical coding.
Data were obtained from eight unique community provider offices (8 sites) at which 29 prescribers practice. The pain points identified represented five main categories: 1) information transfer gaps; 2) format disparities; 3) outdated technologies; 4) care consequences; and 5) workarounds. Prescribers and their staff suggested improvements that included real time eligibility and formulary alerts regarding PA during the e-prescribing process, accurate, up-to-date formulary data with easy-to-access alternatives, and embedded PA that is integrated with electronic medical record data. Three sites used medication PA portals such as CoverMyMeds for information gathering, but at the time of data collection, no sites used these PA portals for prospective electronic prior authorization (ePA) or the electronic process of requesting authorization from health plan payers for coverage.
The PA process for medication used by community providers is in urgent need of modernization. Pain points identified in this study could be alleviated by implementing medication ePA solutions. However, providers and their staff are largely unaware that ePA exists. Additional research in this area is needed.
社区医疗机构用药的事先授权（PA）流程需要现代化。因此，从社区医疗机构提供者的角度深入了解当前 PA 的状况对于告知和现代化这一管理式医疗工具至关重要。
本研究的目的是从提供者实践的角度识别、分析和分类与药物 PA 流程相关的问题。
采用前瞻性非实验性、横断面、观察性研究方法，对美国亚利桑那州图森市的 8 个初级保健和医学亚专科小组实践进行半结构式访谈和直接观察。参与的实践必须有既定的药物 PA 流程。每个地点的参与者反馈使用 Richards 定性编码技术进行分析，该技术包括描述性编码、主题编码和分析性编码。
数据来自美国亚利桑那州图森市的 8 个独特的社区提供者办公室（8 个地点），其中有 29 名处方医生。确定的痛点代表五个主要类别：1）信息传递差距；2）格式差异；3）过时的技术；4）护理后果；和 5）权宜之计。处方医生及其工作人员提出了一些改进建议，包括在电子处方过程中实时获取资格和处方集警报、提供准确、最新的处方集数据和易于获取的替代方案，以及嵌入式 PA 与电子病历数据集成。有三个地点使用了 CoverMyMeds 等药物 PA 门户来收集信息，但在数据收集时，没有一个地点使用这些 PA 门户进行前瞻性电子事先授权（ePA）或向健康计划支付者请求覆盖范围的电子授权流程。
社区医疗机构用药的 PA 流程急需现代化。本研究中确定的痛点可以通过实施药物 ePA 解决方案来缓解。然而，提供者及其工作人员在很大程度上不知道 ePA 的存在。需要在这一领域进行更多的研究。
