评估两项旨在改善药物预先授权流程的举措的实施结果（可接受性、采用情况和可行性）。
Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process.
作者信息
Jones Laney K, Ladd Ilene G, Gregor Christina, Evans Michael A, Graham Jove, Gionfriddo Michael R
机构信息
Geisinger Health System, 100 N Academy Avenue, Danville, PA, 17822, USA.
出版信息
BMC Health Serv Res. 2021 Nov 20;21(1):1259. doi: 10.1186/s12913-021-07287-2.
BACKGROUND
Processes such as prior authorization (PA) for medications, implemented by health insurance companies to ensure that safe, appropriate, cost-effective, and evidence-based care is provided to all members, have created inefficiencies within healthcare systems. Thus, healthcare systems have implemented supplemental processes to reduce burden and ensure efficiency, timeliness, and appropriate care.
OBJECTIVE
Evaluate implementation outcomes of two initiatives related to PA for medications: a common record that records all PA-related information that was integrated into the health record and an auto-routing of specialty prescriptions to a hospital-owned specialty pharmacy.
METHODS
We conducted semi-structured interviews with medical staff to understand their experience, acceptability, adoption, and feasibility of these initiatives guided by Proctor's Framework for Implementation Outcomes. Transcripts were analyzed using consensus coding.
RESULTS
Eleven medical staff participated in semi-structured interviews. The two initiatives were analyzed together because the findings were similar across both for our outcomes of acceptability, adoption, and feasibility. Participants found the implemented initiatives to be acceptable and beneficial but felt there were still challenges with the new workflow. The initiatives were fully adopted by only one clinic site within the healthcare system, but limitations arose when adopting to another site. Individuals felt the initiatives were feasible and improved workflow, communication, and transparency. However, participants described future adaptations that would help improve this process including improved standardization, automation, and transparency.
CONCLUSION
The acceptability, adoption, and feasibility of two initiatives to improve the PA process within the one clinical site were well received but issues of generalizability limited the initiatives adoption system wide.
背景
医疗保险机构实施的诸如药物预先授权（PA）等流程，旨在确保为所有成员提供安全、适当、具有成本效益且基于证据的医疗服务，但这些流程在医疗系统中造成了效率低下的问题。因此，医疗系统已实施补充流程以减轻负担并确保效率、及时性和适当的医疗服务。
目的
评估与药物PA相关的两项举措的实施效果：一个记录所有与PA相关信息并整合到健康记录中的通用记录，以及将专科处方自动路由到医院所属专科药房。
方法
我们对医务人员进行了半结构化访谈，以了解他们在普罗克特实施效果框架指导下对这些举措的体验、可接受性、采用情况和可行性。使用共识编码对访谈记录进行分析。
结果
11名医务人员参与了半结构化访谈。由于在可接受性、采用情况和可行性方面的结果相似，因此对这两项举措进行了综合分析。参与者认为已实施的举措是可接受且有益的，但觉得新工作流程仍存在挑战。这些举措仅在医疗系统内的一个诊所完全采用，但在推广到另一个诊所时出现了局限性。个人认为这些举措是可行的，并且改善了工作流程、沟通和透明度。然而，参与者描述了未来有助于改进此过程的调整措施，包括改进标准化、自动化和透明度。
结论
在一个临床站点内改善PA流程的两项举措的可接受性、采用情况和可行性受到好评，但普遍性问题限制了这些举措在整个系统中的采用。
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