Supporting Use of AC Through Provider Profiling of Oral AC Therapy for AF

Not Applicable

Completed

• Conditions: Prescribing Practices; Atrial Fibrillation; Anticoagulants
• Interventions: Behavioral: Anticoagulation (AC) Intervention--Academic Detailing; Behavioral: Anticoagulation (AC) Intervention--Prescribing Practices

• Registration Number: NCT03583008
• Lead Sponsor: University of Massachusetts, Worcester

Brief Summary

The SUPPORT-AF study aims to improve rates of anticoagulation (AC) in atrial fibrillation (AF) patients by developing and delivering supportive tools and educational materials to providers treating patients with AF. The investigators hypothesize that AC percentage will increase among providers receiving tools and educational content.

Detailed Description

Nearly 1 million patients with atrial fibrillation (AF) who meet guideline criteria for anticoagulation (AC) are being left untreated, often due to providers over-estimating risks of bleeding and falling and under-estimating risks of stroke. The objective of this project is to improve rates of adherence to AC guidelines by creating supportive and educational materials for cardiology as well as primary care providers to evaluate the risks and benefits of prescribing AC to patients with AF. The investigators will email providers individual auto-updating reports containing their AC prescription rate compared to their peers and compared to practice level AC prescription goal. This report will also contain a list of the provider's AF patients who are eligible to receive AC based on their CHA2DS2-VASc stroke risk score ≥ 2 and a list of eligible AF patients with upcoming appointments to focus providers on an actionable group of patients with whom they might review the use of AC. The investigators will also message providers through the EHR prior to an upcoming appointment with an eligible patient reminding them to discuss AC if they deem appropriate. In addition, the investigators will directly engage with providers through academic teledetailing to educate providers on AC and address misconceptions and barriers to initiating or resuming AC in AF patients.

Study Timeline

• Study Start: 2018-06-11
• Study First Submitted: 2018-06-26
• Study First Submitted QC: 2018-07-09
• Study First Posted: 2018-07-11
• Primary Completion: 2019-02-01
• Status Verified: 2019-03
• Study Completion: 2019-03-01
• Last Update Submitted: 2019-03-19
• Last Update Posted: 2019-03-21

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 112

Inclusion Criteria

• University of Massachusetts providers caring for patients aged 18 years and older with ICD-10 diagnostic code consistent with AF or atrial flutter who had a visit with a primary care provider or
• cardiovascular medicine specialist in the previous one year with the diagnosis of AF present as an active diagnosis in the electronic medical record (EHR).

Exclusion Criteria

• University of Massachusetts providers who do not care for patients aged 18 years and older with ICD-10 diagnostic code consistent with AF or atrial flutter who had a visit with a primary care provider or
• cardiovascular medicine specialist in the previous one year with the diagnosis of AF present as an active diagnosis in the EHR.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Anticoagulation (AC) Intervention	Anticoagulation (AC) Intervention--Prescribing Practices	Providers in this arm will receive supportive tools including Anticoagulation (AC) Intervention--Prescribing Practices and Anticoagulation (AC) Intervention--Academic Detailing to help them assess their Anticoagulant (AC) prescribing practices and will also meet with the study investigators for academic detailing.
Anticoagulation (AC) Intervention	Anticoagulation (AC) Intervention--Academic Detailing	Providers in this arm will receive supportive tools including Anticoagulation (AC) Intervention--Prescribing Practices and Anticoagulation (AC) Intervention--Academic Detailing to help them assess their Anticoagulant (AC) prescribing practices and will also meet with the study investigators for academic detailing.

Primary Outcome Measures

Name	Time	Method
Change to Provider prescription rates	Intervention to three months post intervention.	The first primary outcome measure is to determine the impact of the intervention on provider prescribing rates (increase, decrease, same)
Change to Individual patient Anticoagulation (AC) status	Intervention to three months post intervention.	The effect of the intervention on individual patient anti-coagulation status as demonstrated by random effects logistic regression models for post-intervention AC status (anticoagulated / not anticoagulated) as a function of pre-intervention AC status.

Secondary Outcome Measures

Name	Time	Method
Change in provider confidence in applying evidence to balance stroke prevention with harm.	Intervention to three months post intervention.	The change in provide confidence as assessed by confidence questions included in the provider survey distributed with the AC Provider Profile. More specifically, the change is calculated with an average score for each item in the confidence survey, using a four-point scale based on four response choices - not confident through very confident.

Trial Locations

Locations (1)

UMass Medical School; 🇺🇸 Worcester, Massachusetts, United States