Background New oral anticoagulants (NOAC), such as apixaban, rivaroxaban and dabigatran, are indicated for stroke prevention in atrial fibrillation and acute thromboembolic events. Provision of treatment with NOAC is contingent on prior administrative approval according to district criteria in order to obtain the health service provider’s discount. Before our project, there was no clear policy for submission of requests when starting treatment with NOAC during hospitalisation. Many patients discharged from our hospital with a prescription for NOAC without the administrative approval chose not to purchase the drug at full price and to turn to the family physician to request administrative approval. As a result, a gap in medical treatment may occur which puts the patient at risk that may have negative consequences on their health state.

Purpose To establish a process and implement a workflow for requesting administrative approval when starting NOAC treatment during hospitalisation.

Material and methods

1. Mapping the desired process for requesting administrative approval for new treatment with NOAC for patients members of Clalit Health Services (CHS), the largest health maintenance organisation (HMO) in Israel. Meir Medical Centre belongs to Clalit HMO.

2. Creating a request form for the administrative approval.

3. Presenting the process in the internal wards.

4. Implementing the process and conducting a pilot in internal wards while monitoring sending requests and receiving administrative approval for the treatment.

Results Before starting our project, we collected data regarding request submission when starting treatment with NOAC. We found that of 42 patients (members of Calit HMO) who started a new treatment, only 1 (2.4%) approval request was sent during hospitalisation. Preliminary data at the end of a month of a pilot in 3 internal wards showed that treatment with NOAC was started for 32 patients. 22 (68.7%) were members of Clalit HMO. For 14 (63.6%), a request form for the administrative approval was sent while they were still hospitalised.

Conclusion By establishing a process for requesting administrative approval for new treatment with NOAC during hospitalisation, we improved patient safety and ensured continuity of treatment with these important drugs during transition from the hospital to the community setting.

References and/or acknowledgements Acknowledgement for internal ward’s staff.

No conflict of interest