Effects of a psychotherapeutic drug prior authorization (PA) requirement on patients and providers: a providers' perspective.

This study describes the effects of a Texas Medicaid PA requirement for psychotherapeutic medications from the perspective of mental health care providers. Three focus groups were conducted and a content analysis was performed on the generated transcripts. Providers identified five categories of issues that are relevant to the PA process: (1) system/administrative factors; (2) costs/ outcomes; (3) prescribing issues; (4) evaluation criteria; and (5) patient-provider relationship and patient visit. Administrative burden and unintended patient outcomes were the most frequently reported issues related to PA. However, all five issues represent important factors that providers deal with when caring for patients with mental illness.

Attitudes and interests of pharmacists regarding independent pharmacy ownership.

OBJECTIVE: To examine the beliefs, attitudes, and interests of Texas pharmacists at different career stages with respect to independent pharmacy ownership. DESIGN: Non-experimental, cross-sectional study. SETTING: Texas in November-December 2004. PARTICIPANTS: 180 practicing pharmacists. INTERVENTION: Mail survey. MAIN OUTCOME MEASURES: Pharmacists' self-reported attitudes (ranging from -90, unfavorable, to +90, favorable) about and interest (-3, very unlikely, to +3, very likely) in independent pharmacy ownership. RESULTS: Pharmacists reported an overall favorable attitude toward independent pharmacy ownership (mean [+/- SD] 18.6 +/- 28, range -63.0 to 90.0). Beliefs that ownership would increase their business autonomy, professional autonomy, and ability to establish patient loyalty made the largest contributions to overall attitude. Pharmacists' attitudes toward ownership differed by career stage (F = 3.12, df = 2, P = 0.047), with middle- (age 36-49 years) and early- (age < or = 35 years) career-stage pharmacists reporting the most and least favorable attitudes, respectively. Pharmacists reported a low interest in pursuing ownership (-2.2 +/- 1.6, -3.0 to +3.0). Financial rewards (r = 0.26, P < 0.001) and the need for business/managerial skills (r = 0.25, P < 0.001) were most highly correlated with pharmacists' interest in pursuing ownership. Multivariate findings indicated that pharmacists with a higher interest in pursuing ownership and those with advanced training certifications had significantly more favorable attitudes toward ownership than their counterparts. In addition, interest in pursuing pharmacy ownership was higher in pharmacists who offered compounding services, could obtain financial resources, practiced in rural locations, and had more favorable attitudes toward ownership. CONCLUSION: Overall, pharmacists indicated favorable attitudes toward independent pharmacy ownership but low interest in pursuing ownership. Their attitudes differed based on career stage, and more favorable attitudes--grounded especially in beliefs about autonomy and patient loyalty--were associated with a greater interest in ownership. Strategies to stimulate pharmacy ownership should be varied and targeted to influence beliefs that are driving pharmacists' attitudes at various career stages.