Heart Failure
Conditions
Keywords
Pharmacist, Medication therapy
Brief summary
This is a randomized quality improvement project to evaluate the impact of an audit and feedback intervention to motivate pharmacists to provide heart failure (HF) medication management to patients in the Veterans Health Administration (VHA) Sierra Pacific region (VISN 21). The results of this project could provide guidance for how to successfully scale a pharmacist-based HF remote management program in the VHA more broadly. Pharmacists providing clinical care as part of Patient Aligned Care Team (PACT) within VHA VISN 21 will be included. Pharmacists will be randomized to one of 3 arms in a 1:1:2 ratio: (1) monthly audit and feedback of HF medication titration activities (AF) vs. (2) educational resources and monthly notification of HF medication titration actions in addition to a list of potential patients for HF optimization (AF+) vs. (3) usual care without audit and feedback (UC). Pharmacists across all three arms will be given access to shared educational resources on HF pharmacist care and educational webinars. Six months after the intervention, rates of pharmacist HF medication titration encounters will be compared among the 3 groups.
Interventions
OTHERAudit and Feedback Emails
Monthly email containing information including their total medication titration encounters over a 3 month period, as well as the site and VISN level for comparison. This will include rates of GDMT utilization and percentage of patients on \>50% of the target dose of GDMT stratified by site, VISN and national. This data will be obtained from VHA national HF dashboard.
OTHERPatient Specific Targets
Monthly emails include a list of 5-7 HF patients who are potentially eligible for pharmacist HF medication titration. This data will be obtained from VHA national HF dashboard.
OTHEREducational Resources
Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.
Sponsors
VA Palo Alto Health Care System
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Clinical pharmacists in the Veterans Health Administration that provide Patient Aligned Care Team (PACT) care in VA Sierra Pacific Network (VISN 21)
Exclusion criteria
* Excluded per pharmacist supervisor decision
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of monthly heart failure medication adjustment encounters | 2 months post-randomization to 6 months post-randomization | Encounters in which pharmacist adjusted heart failure medications |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of new patients with pharmacist HF management | Within 6 months post-randomization | For each pharmacist, will calculate the number of patients with heart failure in their panel that receive care from pharmacist that were not receiving care prior to randomization |
| Guideline medical therapy score | At 6 months post randomization | Composite score of heart failure medical therapy among patients with heart failure for patients within each pharmacists panel |
| Beta-blocker therapy | At 6 months post randomization | Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with beta-blocker therapy |
| Percentage of heart failure patients with medication management by pharmacist | Within 6 months post-randomization | For each pharmacist, will calculate the percentage of patients with heart failure in their panel that receive medication adjustments from pharmacist |
| Angiotensin receptor neprilysin inhibitor (ARNI) therapy | At 6 months post randomization | Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with ARNI therapy |
| Mineralocorticoid receptor antagonist (MRA) therapy | At 6 months post randomization | Percentage of patients with heart failure in each pharmacist panel that are treated with MRA therapy |
| Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) therapy | At 6 months post randomization | Percentage of patients with heart failure in each pharmacist panel that are treated with SGLT2i therapy |
| Renin-angiotensin system inhibitor (RASI) therapy | At 6 months post randomization | Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with RASI therapy |
Countries
United States
Outcome results
None listed