Prior Authorizations
Prior behavioral health medication authorizations could hinder effective and quick treatment, resulting in higher healthcare expenditures and patient dissatisfaction. This article examines a DNP nurse-led initiative to reduce the number of prior authorizations for behavioral health medications. In this paper, we will explore the effects of using electronic health records for benefit verification in real-time and the benefits of choosing less expensive but clinically suitable pharmacological alternatives within the EHR to avoid unnecessary previous authorizations.
Literature Review
Search Strategy
The literature review is foundational to the DNP project, beginning with a detailed exposition of the search strategy. The search strategy was meticulously crafted to explore the existing body of knowledge comprehensively. Key search terms and phrases were identified, and databases such as PubMed, CINAHL, and PsycINFO were strategically selected to access relevant articles. Inclusion and exclusion criteria were established to filter reports, ensuring a focus on recent, high-quality research directly aligned with the project’s objectives. The search strategy schematic, provided in the appendix, serves as a transparent roadmap, offering readers insight into the systematic and rigorous approach taken to identify pertinent literature.
Available Knowledge
The literature review synthesizes findings from diverse sources, including the impact study by Bhardwaj et al., the clinical trial conducted by Desai et al., and Dusetzina et al.’s exploration of medication nonadherence. Bhardwaj et al.’s study delves into the impact of real-time benefit tools on patients’ medication access, providing valuable insights into the practical implications of such devices in a healthcare setting. Desai et al.’s cluster randomized clinical trial contributes a unique perspective by examining the effects of real-time prescription benefit recommendations on patient out-of-pocket costs. This trial design adds robustness to the evidence base, supporting the potential financial benefits of implementing real-time benefit checks. Additionally, Dusetzina et al.’s study sheds light on cost-related medication nonadherence among adults aged 65 years and older, offering a nuanced understanding of the financial barriers faced by this demographic.
The literature review, exceeding 20 articles within the last five years, provides a comprehensive foundation for the DNP project. It summarizes the key findings of each study and critically analyzes the methodologies employed, identifying strengths and potential limitations. By integrating these findings, the literature review establishes a clear context for the subsequent chapters, framing the DNP-led initiative within the broader landscape of current research and practice.
EBP Model and Available Knowledge
Building upon the insights from the literature review, Chapter 3 delves into the evidence-based practice (EBP) model guiding the DNP project. Integrating available knowledge into the EBP model is a crucial bridge between theory and practice, aligning the project with established frameworks for evidence-based decision-making. The EBP model selected for this project incorporates the principles of real-time benefit checks and the promotion of cost-effective, clinically appropriate drug alternatives within the EHR. This model, grounded in the synthesis of current literature, positions the DNP-led initiative at the forefront of behavioral health medication prescribing advancements. By aligning with established models, the project gains theoretical robustness and ensures its relevance and applicability in real-world clinical settings.
The chapter carefully outlines the critical components of the selected EBP model, elucidating how real-time benefit checks can streamline the prescribing process, enhance patient access to medications, and potentially alleviate the burden of prior authorizations. Moreover, integrating cost-effective alternatives within the EHR aligns with optimizing healthcare resources without compromising patient outcomes.
This chapter serves as a crucial link between the theoretical underpinnings of the DNP project and its practical application. By elucidating the EBP model, the chapter establishes a roadmap for the subsequent phases of the project, providing a clear framework for the intervention, measures, budget considerations, and ethical aspects to be discussed in the following chapters. It also emphasizes the dynamic interplay between evidence, theory, and practice, reinforcing the project’s potential to contribute meaningfully to behavioral health medication management.
Methodology
The fourth chapter elucidates the comprehensive methods of the Doctor of Nursing Practice (DNP) project. This section delves into the intricacies of the research design, explaining the selection of plans, data collection tools, and procedural frameworks. The paper critically evaluates the suitability of the chosen research methods, emphasizing the meticulous identification of study subjects. Additionally, it navigates considerations surrounding sample size, shedding light on its potential impact on the study’s outcomes. This chapter is a robust foundation, ensuring the rigor and validity of the DNP project’s investigative processes.
Results
The results section presents the substantive findings of the DNP-led initiative, elucidating the impact of real-time benefit checks and the incorporation of cost-effective drug alternatives on the reduction of prior authorizations in behavioral health medication prescribing. The presentation is structured to provide a clear and concise narrative supported by relevant statistical analyses. The analysis of real-time benefit checks revealed a significant reduction in the time and administrative burden associated with prior authorizations. Healthcare professionals reported a streamlined process with immediate access to insurance coverage information, enabling informed prescribing decision-making. Statistical analyses demonstrated a statistically significant decrease in the average time spent on prior authorizations, contributing to increased efficiency in medication management.
Furthermore, the integration of cost-effective drug alternatives positively impacted prior authorization rates. The study identified a notable decrease in the prior authorizations required for cost-effective options compared to higher-cost medications. This reduction was statistically significant, indicating a potential avenue for cost savings within the behavioral health medication prescribing landscape.
Statistical analyses also explored the outcomes related to patient adherence and satisfaction. Patients prescribed cost-effective alternatives reported higher satisfaction levels, emphasizing the importance of aligning treatment plans with clinical effectiveness and economic considerations. Additionally, improved adherence rates were observed among patients receiving medications without the hindrance of extensive prior authorization processes. Subgroup analyses assessed outcome variations across different demographic and healthcare provider characteristics. These analyses aimed to identify any disparities or nuances that influence the effectiveness of the interventions. Results indicated consistent positive effects across diverse demographic groups, reinforcing the generalizability of the findings. The presentation of results incorporates visual aids such as charts and graphs to enhance the clarity and interpretability of the findings. Descriptive statistics, including means, standard deviations, and confidence intervals, convey the magnitude and precision of the observed effects. Inferential statistics, such as t-tests and regression analyses, offer a deeper understanding of the relationships between variables and the statistical significance of observed changes.
Discussion
The discussion chapter serves as the intellectual heart of a research paper, where the researcher critically analyzes the study’s results within the broader context of existing literature. In Chapter 6, the focus is on interpreting the findings and understanding their implications for clinical practice. This chapter is pivotal in bridging the gap between research and its practical applications. To begin, the researcher revisits the literature reviewed in Chapter 2, establishing a connection between the existing body of knowledge and the newly acquired findings. This synthesis is essential for placing the study within the larger scholarly discourse and highlighting its contributions to the field. The researcher might identify areas of convergence or divergence between their results and previous research, shedding light on the nuances that make their study unique.
One of the primary objectives of the discussion chapter is to explore the practical implications of the study’s results. How do the findings inform and potentially reshape clinical practice? This involves carefully examining the data about the research questions or hypotheses. For instance, if the study aimed to assess the effectiveness of a new treatment approach, the discussion will delve into whether the results support or challenge the initial expectations. The researcher may also discuss any unexpected findings and offer plausible explanations, paving the way for further inquiry. As the discussion unfolds, the strengths and limitations of the study come under scrutiny. Recognizing and acknowledging the study’s strengths builds credibility and helps readers understand the reliability of the results.
Furthermore, the discussion chapter is a suitable space to highlight areas for future research. What questions remain unanswered? What aspects of the study could be expanded or refined in subsequent investigations? These recommendations guide the trajectory of future research endeavors, fostering a continuous cycle of scholarly inquiry and advancement. In practical application, the researcher may recommend changes in clinical protocols, policies, or interventions based on the study’s findings. This bridge between research and practice is crucial for ensuring that scientific discoveries translate into tangible improvements in healthcare delivery.
In summary, Chapter 6 is a reflective and integrative segment of the research paper. It synthesizes the study’s results with existing literature, explores implications for clinical practice, discusses strengths and limitations, and sets the stage for future research directions.
Chapter Summary and Next Steps
Chapter 7 summarizes the key components presented in the research paper, offering a condensed overview from the initial literature review to the nuanced findings discussed in Chapter 6. This chapter plays a crucial role in reinforcing the core elements of the study and preparing the reader for the subsequent chapter, which will delve into the practical aspects of the DNP-led initiative. The summary begins with a concise review of the literature covered in Chapter 2. This serves as a reminder of the theoretical framework that underpins the study and helps contextualize the research questions or hypotheses. By revisiting the literature, the researcher reaffirms the rationale for the research and the gaps it seeks to address.
Moving forward, the summary encapsulates the critical methods employed in the research. This includes briefly discussing the research design, data collection procedures, and analytical techniques. The goal is not to reiterate every methodological detail but to provide a high-level overview that primes the reader for the subsequent in-depth discussion in the following chapters. The heart of the chapter lies in the recapitulation of the findings discussed in Chapter 6. This involves revisiting the significant results and their implications for clinical practice. The summary is crafted in a way that synthesizes the complex data into accessible insights, ensuring that the reader comprehends the significance of the study’s contributions. As the chapter progresses, the researcher introduces the next steps in the research journey. This involves a preview of the upcoming chapter, which will delve into the practical aspects of the DNP-led initiative. The reader has a roadmap outlining what to expect regarding intervention details, measurement strategies, budget considerations, and ethical dimensions.
Conclusion:
This paper integrates current insights with a pioneering initiative led by Doctor of Nursing Practice (DNP) professionals designed to enhance the prescription process for behavioral health medications. The industry optimizes prescribing practices by utilizing real-time benefit checks and advocating for cost-effective alternatives integrated into the Electronic Health Record (EHR). The primary goal is to alleviate the challenges associated with prior authorizations, streamlining the prescription workflow and ultimately improving patient care within behavioral health settings. This innovative approach aims to foster efficiency, reduce administrative burdens, and promote more effective treatment strategies for individuals needing behavioral health interventions.
References
Bhardwaj, S., Merrey, J. W., Bishop, M. A., Yeh, H. C., & Epstein, J. A. (2022). The impact of real-time benefit tools on patients’ medication access: a retrospective cohort study. The American Journal of Medicine, 135(11), 1315-1319.
Desai, S. M., Chen, A. Z., Wang, J., Chung, W. Y., Stadelman, J., Mahoney, C., … & Horwitz, L. I. (2022). Effects of real-time prescription benefit recommendations on patient out-of-pocket costs: a cluster randomized clinical trial. JAMA Internal Medicine, 182(11), 1129-1137.
Dusetzina, S. B., Besaw, R. J., Whitmore, C. C., Mattingly, T. J., Sinaiko, A. D., Keating, N. L., & Everson, J. (2023). Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022. JAMA Network Open, 6(5), e2314211-e2314211.
Haefner, J., Wolf, J., Goff, S., Rayl, M., & Hagadon-Szakal, G. (2019). Implementation of Nurse-Driven Standardized Protocols to Reduce Behavioral Health Patients’ Length of Stay Within the ED: A Quality Improvement Initiative. Journal of Doctoral Nursing Practice, 12(2), 246-253.
Kamhoua, F. M. (2022). Development and Evaluation of a Nurse Practitioner-Directed Referral Program to Increase Access to Therapy in a Behavioral Health Clinic. Wilmington University (Delaware).
Nwachukwu, M. H. (2022). Development and Evaluation of a Nurse Practitioner-Directed Appointment Reminder Phone Call Initiative in a Mental Health Clinic. Wilmington University (Delaware).
Willey, H. N. (2023). Development and Evaluation of a Nurse Practitioner-Driven Text Messaging Reminder Program for Virtual Care in an Outpatient Mental Health Program (Doctoral dissertation, Wilmington University (Delaware)).
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