Veterans Affairs Pharmacist Heart Failure Medication Titration Project 1

NCT06099808 | Enrolling By Invitation

• 1 other identifier: 72662
• Study Type: interventional
• Target: 110
• Locations: 1 country
• Sites: 1

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.

Conditions

Heart Failure

Keywords

Pharmacist; Medication therapy

Outcome Measures

Primary Outcomes (1)

• Number of monthly heart failure medication adjustment encounters

  Encounters in which pharmacist adjusted heart failure medications

  2 months post-randomization to 6 months post-randomization

Secondary Outcomes (8)

• Percentage of heart failure patients with medication management by pharmacist

  Within 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

• Beta-blocker therapy

  At 6 months post randomization

• Renin-angiotensin system inhibitor (RASI) therapy

  At 6 months post randomization

Study Arms (3)

Audit and Feedback (AF)

EXPERIMENTAL

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.

Other: Audit and Feedback Emails; Other: Educational Resources

Audit and Feedback with Patient Specific Targets (AF+)

EXPERIMENTAL

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.

Other: Audit and Feedback Emails; Other: Patient Specific Targets; Other: Educational Resources

Usual Care

ACTIVE COMPARATOR

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.

Other: Educational Resources

Interventions

Audit and Feedback Emails OTHER

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.

Audit and Feedback (AF); Audit and Feedback with Patient Specific Targets (AF+)

Patient Specific Targets OTHER

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.

Audit and Feedback with Patient Specific Targets (AF+)

Educational Resources OTHER

Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Audit and Feedback (AF); Audit and Feedback with Patient Specific Targets (AF+); Usual Care

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinical pharmacists in the Veterans Health Administration that provide Patient Aligned Care Team (PACT) care in VA Sierra Pacific Network (VISN 21)

You may not qualify if:

• Excluded per pharmacist supervisor decision

Sponsors & Collaborators

• Stanford University: lead
• VA Palo Alto Health Care System: collaborator

Study Sites (1)

Palo Alto Veteran's Affairs Hospital

Palo Alto, California, 94304, United States

Location

MeSH Terms

Conditions

Heart Failure

Condition Hierarchy (Ancestors)

Heart Diseases; Cardiovascular Diseases

Study Officials

• Paul A Heidenreich, MD, MS

  Stanford University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Medicine

Study Record Dates

• First Submitted: October 18, 2023
• First Posted: October 25, 2023
• Study Start: November 20, 2023
• Primary Completion: June 30, 2024
• Study Completion: September 30, 2024
• Last Updated: April 17, 2024

Record last verified: 2024-04

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)