Impact of a pharmacist-run refill and prior authorization program on physician workload.

BACKGROUND: 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. OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Assessment of students' satisfaction with a student-led team-based learning course.

PURPOSE: To date, no studies in the literature have examined student delivery of team-based learning (TBL) modules in the classroom. We aimed to assess student perceptions of a student-led TBL elective. METHODS: Third-year pharmacy students were assigned topics in teams and developed learning objectives, a 15-minute mini-lecture, and a TBL application exercise and presented them to student colleagues. Students completed a survey upon completion of the course and participated in a focus group discussion to share their views on learning. RESULTS: The majority of students (n=23/30) agreed that creating TBL modules enhanced their understanding of concepts, improved their self-directed learning skills (n=26/30), and improved their comprehension of TBL pedagogy (n=27/30). However, 60% disagreed with incorporating student-generated TBL modules into core curricular classes. Focus group data identified student-perceived barriers to success in the elective, in particular the development of TBL application exercises. CONCLUSION: This study provides evidence that students positively perceived student-led TBL as encouraging proactive learning from peer-to-peer teaching.

A retrospective cohort study of a nurse-driven computerized insulin infusion program versus a paper-based protocol in critically ill patients.

BACKGROUND: There is variability in the extent of outcome achievement between computerized insulin infusion programs (CIIPs) and paper-based protocols (PBPs). This reported variability may be improved by intensive CIIP training prior to implementation. The objective was to evaluate the impact of a CIIP following intensive nurse training versus a PBP in a critical care setting. METHODS: A retrospective cohort study was performed on patients admitted to a mixed intensive care unit comparing glucose control between the CIIP following intensive training and a PBP. Consecutive patients on each protocol were assessed to obtain glucose concentrations and outcomes. The primary measure was the percentage of blood glucose values within target range (90-130 mg/dL). Patient glucose values were pooled and assessed using the χ(2) test for independence. RESULTS: In total, 61 patients with 5,495 glucose tests were included in the PBP group, and 51 patients with 5,645 glucose tests in the CIIP group. A greater percentage of glucose tests was within target range in the CIIP group (68.4% vs. 36.5%, P<0.001). In the CIIP group, time-to-target (median [interquartile range] 5 [3-8] h vs. 7 [4-20] h, P=0.02) and severe hypoglycemic events were reduced (26 vs. 6, P<0.0001). CONCLUSIONS: The nurse-driven CIIP led to a higher percentage of glucose values within target range, faster achievement of target glucose values, and a reduction in the number of severe hypoglycemic events. This improved outcome achievement compared with previous reports may be associated with intensive user training.