Randomized Evaluation of Audit and Feedback Intervention to Promote Pharmacist Heart Failure Medication Titration in Veterans Affairs Sierra Pacific Network
Trial Snapshot
- Phase
- Not Applicable
- Status
- Enrolling By Invitation
- Sponsor
- Stanford University
- Enrollment
- 110
- Locations
- 2
- Primary Endpoint
- Number of monthly heart failure medication adjustment encounters
Study Overview
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.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts 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
Outcomes
Primary Outcomes
Number of monthly heart failure medication adjustment encounters
Time Frame: 2 months post-randomization to 6 months post-randomization
Encounters in which pharmacist adjusted heart failure medications
Secondary Outcomes
- 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)
- Mineralocorticoid receptor antagonist (MRA) therapy(At 6 months post randomization)
Investigators
Paul A. Heidenreich
Professor of Medicine
Stanford University