Randomized Evaluation of Audit and Feedback Intervention to Promote Pharmacist Heart Failure Medication Titration in Veterans Affairs Sierra Pacific Network
试验速览
- 阶段
- 不适用
- 入组人数
- 110
- 试验地点
- 1
- 主要终点
- Number of monthly heart failure medication adjustment encounters
研究概览
简要总结
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Clinical pharmacists in the Veterans Health Administration that provide Patient Aligned Care Team (PACT) care in VA Sierra Pacific Network (VISN 21)
排除标准
- •Excluded per pharmacist supervisor decision
研究组 & 干预措施
Audit and Feedback (AF)
Pharmacists randomized to audit and feedback will receive a 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. The audit and feedback email will also contain rates of medical therapy and percentage of patients on >50% of the target dose of medical therapy stratified by site, VISN and national. This data will be obtained from VHA national HF dashboard. Pharmacists in AF will also receive invitations to monthly educational sessions and access to shared resources on HF medication management.
干预措施: Audit and Feedback Emails (Other)
Audit and Feedback (AF)
Pharmacists randomized to audit and feedback will receive a 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. The audit and feedback email will also contain rates of medical therapy and percentage of patients on >50% of the target dose of medical therapy stratified by site, VISN and national. This data will be obtained from VHA national HF dashboard. Pharmacists in AF will also receive invitations to monthly educational sessions and access to shared resources on HF medication management.
干预措施: Educational Resources (Other)
Audit and Feedback with Patient Specific Targets (AF+)
Pharmacists randomized to the AF+ group will receive the audit and feedback intervention described above with the addition of a list of 5-7 HF patients who are potentially eligible for pharmacist HF medication titration. These patients will be identified using the VHA national HF dashboard.
干预措施: Audit and Feedback Emails (Other)
Audit and Feedback with Patient Specific Targets (AF+)
Pharmacists randomized to the AF+ group will receive the audit and feedback intervention described above with the addition of a list of 5-7 HF patients who are potentially eligible for pharmacist HF medication titration. These patients will be identified using the VHA national HF dashboard.
干预措施: Patient Specific Targets (Other)
Audit and Feedback with Patient Specific Targets (AF+)
Pharmacists randomized to the AF+ group will receive the audit and feedback intervention described above with the addition of a list of 5-7 HF patients who are potentially eligible for pharmacist HF medication titration. These patients will be identified using the VHA national HF dashboard.
干预措施: Educational Resources (Other)
Usual Care
Pharmacists randomized to the usual care arm will have access to monthly educational sessions and to shared resources on HF medication management. They will receive no additional feedback.
干预措施: Educational Resources (Other)
结局指标
主要结局
Number of monthly heart failure medication adjustment encounters
时间窗: 2 months post-randomization to 6 months post-randomization
Encounters in which pharmacist adjusted heart failure medications
次要结局
- Mineralocorticoid receptor antagonist (MRA) therapy(At 6 months post randomization)
- Beta-blocker therapy(At 6 months post randomization)
- Number of new patients with pharmacist HF management(Within 6 months post-randomization)
- Guideline medical therapy score(At 6 months post randomization)
- Renin-angiotensin system inhibitor (RASI) therapy(At 6 months post randomization)
- Percentage of heart failure patients with medication management by pharmacist(Within 6 months post-randomization)
- Angiotensin receptor neprilysin inhibitor (ARNI) therapy(At 6 months post randomization)
- Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) therapy(At 6 months post randomization)
研究者
Paul A. Heidenreich
Professor of Medicine
Stanford University