预先授权要求和处方填充模式在心力衰竭患者中.
Amrita Mukhopadhyay1, Samrachana Adhikari2, Xiyue Li2
1Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.
JACC. Advances
|January 25, 2026
概括
预先授权显著延迟或阻止患者填充必要的心力衰竭药物,包括RNAI和SGLT2is. 这些要求不成比例地影响少数群体的患者,造成了拯救生命的治疗障碍.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 预先授权可能会阻碍获得关键心力衰竭 (HF) 药物,如血管激素受体不利素抑制剂 (RNAI) 和糖携运输体2抑制剂 (SGLT2is).
- 这些药物对于降低HF患者的死亡率至关重要.
研究的目的:
- 调查事先授权要求与延迟或减少填写ARNI和SGLT2i处方之间的关系.
- 为了确定患者的人口统计和与这些HF药物的先前授权相关的特征.
主要方法:
- 使用电子健康记录,药房填充数据和社区级数据进行回顾性队列研究.
- 在2021年4月至2023年4月期间,包括新的ARNI或SGLT2i处方的HF患者.
- 分析使用反向概率权重来评估第一次填充时间和永远不填充处方的可能性.
主要成果:
- 对于12.2%的RNAI和14.3%的SGLT2is.需要事先授权.
- 需要事先授权的患者更有可能是年轻人,非西班牙裔黑人或西班牙裔,并且没有医疗保险.
- 预先授权与RNAIs (3.03x) 和SGLT2is (6.75x) 的填充时间显著延长,以及从未填充SGLT2i处方 (2.23x) 的可能性增加.
结论:
- 在黑人和西班牙裔患者中,事先授权要求更为普遍.
- 这些要求作为一个重要的障碍,导致推迟和减少获得指南推的,降低死亡率的HF药物.
- 解决事先授权障碍对于公平的HF管理和改善患者结果至关重要.
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