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Table 1 Description of components of the initiatives to improve the process for completion of medication PA at the healthcare system

From: Evaluating implementation outcomes (acceptability, adoption, and feasibility) of two initiatives to improve the medication prior authorization process

Domain Initiative: Common record Initiative: Auto-referral
Actor(s) - Clinician (e.g. physician, advanced practitioner)
- Front office staff
- Department that specializes in completing PA requests
- Pharmacists at the hospital-owned specialty pharmacy
- Clinician (e.g. physician, advanced practitioner)
- Pharmacists at the hospital-owned specialty pharmacy
- EHR
Action(s) - Clinician (e.g. physician, advanced practitioner) – orders a medication that requires PA and sends it to a pharmacy
- Front office staff – Receives request from clinician regarding PA request for a medication and initiates the common record
- Department that specializes in completing PA requests – Gathers necessary clinical and insurance information to complete the PA request, submits the PA request, and documents within the EHR
- Pharmacists at the hospital-owned specialty pharmacy – Pharmacy receives the medication request and fills and dispenses the medication to the patients after the completion of the PA
- Clinician (e.g. physician, advanced practitioner) – orders a medication that requires PA and sends it to a pharmacy
- Pharmacists at the hospital-owned specialty pharmacy – Pharmacy receives an auto-referral for the prescription (if a specialty medication) to the specialty pharmacy when the clinician orders the medication. If the hospital-owned specialty pharmacy can fill the prescribed medication, they will fill it and dispense it to the patient. The ability to fill a medication is dictated by the patient’s insurance company. If they cannot fill the medication, the hospital-owned specialty pharmacy will send the medication to the appropriate pharmacy based on their insurance.
- EHR – within the medication ordering system, the health record will forward the prescription directly to the hospital-owned specialty pharmacy for a certain list of medications
Target(s) of the action Patient receives prescribed medication for their condition Patient receives prescribed medication for their condition
Temporality Common record is initiated every time the prescribed orders a medication requiring PA Every medication that is ordered by a clinician that is on the auto-referral list
Dose All actors should complete their required pieces when available All clinicians have to use this process
Implementation outcome(s) affected Uptake of all involved PA staff, adoption of the new documentation process, fidelity to the new process Uptake of the specialty pharmacy to fill the medication or forward to another specialty pharmacy the medication
Justification Quality improvement team identified there was no single record of this information within the EHR Quality improvement team found that we were not filling many of the specialty medications ordered by our clinicians and that we could provide improved care to our patients if we were able to fill these medications