J Am Pharm Assoc (2003). 2022 May-Jun;62(3):727-733.e1. doi: 10.1016/j.japh.2021.12.002. Epub 2021 Dec 7.
Pharmacist-led programs centralizing prescription renewals and prior authorization processing have been implemented within health care systems; however, their impact on physician efficiency and the perception of impact on workload are unknown.
The primary objective of this study was to measure the change in physician efficiency score after implementation of the refill and prior authorization pilot program (RPAPP). Secondary objectives included changes in physician and staff perception of workload, changes in Center for Medicare and Medicaid Services (CMS) Star Measures, and program productivity.
This was a retrospective cohort study comparing patient and physician data 12 months before and after RPAPP implementation at an academic medical center. Physician efficiency was an average of 5 metrics that measure performance utilizing the electronic health record. Physician and staff perceptions were measured at baseline and 12 months via a pre- and postsurvey. Changes in CMS Star Measures were captured using the institution's Population Health Department data. RPAPP productivity was defined as the number of refills/prior authorizations processed and laboratory parameters ordered.
On implementation, positive results were seen in average physician efficiency scores for 1 of 2 clinics (P < 0.05). Survey results indicated significantly positive changes in physician and staff perception of workload and satisfaction. The RPAPP appeared to help improve institutional performance for 2 of the 3 CMS Star measures evaluated (P < 0.05).
Evaluation of primary care physician workload is complex. Although external variables may have impacted consistent results, the RPAPP appears to have positive effects on physician efficiency and satisfaction. These results may assist other health care institutions interested in initiating an RPAPP.
在医疗保健系统中已经实施了药师主导的集中处方续方和预先授权处理计划；然而，它们对医生效率的影响以及对工作量的感知影响尚不清楚。
本研究的主要目的是衡量实施补充和预先授权试点计划（RPAPP）后医生效率评分的变化。次要目标包括医生和工作人员对工作量的感知变化、医疗保险和医疗补助服务中心（CMS）星级措施的变化以及计划的生产力变化。
这是一项回顾性队列研究，比较了学术医疗中心实施 RPAPP 前后 12 个月的患者和医生数据。医生效率是利用电子健康记录衡量绩效的 5 项指标的平均值。医生和工作人员的看法是通过基线和 12 个月的预调查和后调查来衡量的。CMS 星级措施的变化是使用机构的人口健康部门数据捕获的。RPAPP 的生产力定义为处理的补充/预先授权数量和订购的实验室参数。
实施后，有 2 个诊所中的 1 个（P<0.05）的平均医生效率得分出现了积极结果。调查结果表明，医生和工作人员对工作量和满意度的看法发生了显著积极的变化。RPAPP 似乎有助于改善机构对 3 项 CMS 星级措施中的 2 项的绩效（P<0.05）。
评估初级保健医生的工作量很复杂。尽管外部变量可能对一致的结果产生了影响，但 RPAPP 似乎对医生的效率和满意度有积极影响。这些结果可能有助于其他有兴趣启动 RPAPP 的医疗机构。
