Top

Published in:

Open Access 01-12-2024 | Chronic Kidney Disease | Study Protocol

Pharmacist-driven outreach initiative to increase prescribing of sodium-glucose cotransporter-2 inhibitors in eligible VHA patients with chronic kidney disease: a study protocol

Authors: Deborah L. Pestka, Daniel Murphy, Pearl Huynh, Jessica A. Rechtzigel, Shari Kjos, Lisa Marie Ellich, Adam N. Kaplan, Brent C. Taylor, Melissa Atwood, Beth A. Polsfuss, Joseph Y. Lee, Areef Ishani

Published in: BMC Nephrology | Issue 1/2024

Abstract

Background

Patients with chronic kidney disease (CKD) are at increased risk for multiple adverse events, several of which have been proven to be less likely with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). As a result, guidelines now recommend SGLT2i be given to those with mild to moderate CKD and type 2 diabetes. The objective of this study is to evaluate if a pharmacist-driven SGLT2i prescribing initiative among eligible patients with CKD and diabetes within the VA could more rapidly improve the adoption of SGLT2i via a pragmatic approach aligned with learning health systems.

Methods

Eligible patients will be identified through an established VA diabetes dashboard. Veterans with an odd social security number (SSN), which is effectively a random number, will be the intervention group. Those with even SSNs will serve as the control while awaiting a second iteration of the same interventional program. The intervention will be implemented in a rolling fashion across one Veterans Integrated Service Network. Our primary outcome is initiation of an SGLT2i. Secondary outcomes will include medication adherence and safety-related outcomes.

Discussion

This project tests the impact of a pharmacist-driven medication outreach initiative as a strategy to accelerate initiation of SGLT2i. The results of this work will not only illustrate the effectiveness of this strategy for SGLT2is but may also have implications for increasing other guideline-concordant care. Furthermore, the utilization of SSNs to select Veterans for the first wave of this program has created a pseudo-randomized interventional trial supporting a pragmatic learning health system approach.

Trial registration

ISRCTN12374636.

Available only for authorised users

2021. Chronic Kidney Disease in the United States, Published, August. 2, 2022. Accessed January 20, 2023. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html.

Said S, Hernandez GT. The link between chronic Kidney Disease and Cardiovascular Disease. J Nephropathol. 2014;3(3):99–104. https://doi.org/10.12860/jnp.2014.19.CrossRefPubMedPubMedCentral

Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular Disease in chronic Kidney Disease: pathophysiological insights and therapeutic options. Circulation. 2021;143(11):1157–72. https://doi.org/10.1161/CIRCULATIONAHA.120.050686.CrossRefPubMedPubMedCentral

Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2023;388(2):117–27. https://doi.org/10.1056/NEJMoa2204233.CrossRef

Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular outcomes, and mortality in type 2 Diabetes. N Engl J Med. 2015;373(22):2117–28. https://doi.org/10.1056/NEJMoa1504720.CrossRefPubMed

Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and renal events in type 2 Diabetes. N Engl J Med. 2017;377(7):644–57. https://doi.org/10.1056/NEJMoa1611925.CrossRefPubMed

Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart Failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451–61. https://doi.org/10.1056/NEJMoa2107038.CrossRefPubMed

McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with Heart Failure and reduced ejection fraction. N Engl J Med. 2019;381(21):1995–2008. https://doi.org/10.1056/NEJMoa1911303.CrossRefPubMed

Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular outcomes in type 2 Diabetes. N Engl J Med. 2019;380(4):347–57. https://doi.org/10.1056/NEJMoa1812389.CrossRefPubMed

10.

Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295–306. https://doi.org/10.1056/NEJMoa1811744.CrossRefPubMed

11.

Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in patients with chronic Kidney Disease. N Engl J Med. 2020;383(15):1436–46. https://doi.org/10.1056/NEJMoa2024816.CrossRefPubMed

12.

American Diabetes Association Professional Practice Committee. 11. Chronic Kidney Disease and Risk Management: standards of Medical Care in Diabetes—2022. Diabetes Care. 2021;45(Supplement1):175–S184. https://doi.org/10.2337/dc22-S011.CrossRef

13.

Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in chronic Kidney Disease. Kidney Int. 2022;102(5S):1–S127. https://doi.org/10.1016/j.kint.2022.06.008.CrossRef

14.

Adhikari R, Jha K, Dardari Z, et al. National trends in Use of Sodium-glucose Cotransporter‐2 inhibitors and Glucagon‐like Peptide‐1 receptor agonists by cardiologists and other specialties, 2015 to 2020. J Am Heart Assoc Cardiovasc Cerebrovasc Dis. 2022;11(9):e023811. https://doi.org/10.1161/JAHA.121.023811.CrossRef

15.

Sangha V, Lipska K, Lin Z, et al. Patterns of prescribing sodium-glucose Cotransporter-2 inhibitors for Medicare Beneficiaries in the United States. Circ Cardiovasc Qual Outcomes. 2021;14(12):e008381. https://doi.org/10.1161/CIRCOUTCOMES.121.008381.CrossRefPubMedPubMedCentral

16.

Eberly LA, Yang L, Eneanya ND, et al. Association of Race/Ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with Diabetes in the US. JAMA Netw Open. 2021;4(4):e216139. https://doi.org/10.1001/jamanetworkopen.2021.6139.CrossRefPubMedPubMedCentral

17.

Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–20. https://doi.org/10.1258/jrsm.2011.110180.CrossRefPubMedPubMedCentral

18.

Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–6. https://doi.org/10.1370/afm.1713.CrossRefPubMedPubMedCentral

19.

Moon J, Kolar C, Brummel A, Ekstrand M, Holtan H, Rehrauer D. Development and validation of a patient satisfaction survey for Comprehensive Medication Management. J Manag Care Spec Pharm. 2016;22(1):81–6. https://doi.org/10.18553/jmcp.2016.22.1.81.CrossRefPubMed

20.

Funk KA, Pestka DL, Roth McClurg MT, Carroll JK, Sorensen TD. Primary care providers believe that Comprehensive Medication Management improves their work-life. J Am Board Fam Med JABFM. 2019;32(4):462–73. https://doi.org/10.3122/jabfm.2019.04.180376.CrossRefPubMed

21.

Isetts BJ, Schondelmeyer SW, Artz MB, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc JAPhA. 2008;48(2):203–11.CrossRef

22.

Budlong H, Brummel A, Rhodes A, Nici H. Impact of Comprehensive Medication Management on Hospital Readmission Rates. Popul Health Manag. 2018;21(5):395–400. https://doi.org/10.1089/pop.2017.0167.CrossRefPubMed

23.

Brummel AR, Soliman AM, Carlson AM, de Oliveira DR. Optimal Diabetes care outcomes following face-to-face medication therapy management services. Popul Health Manag. 2013;16(1):28–34. https://doi.org/10.1089/pop.2012.0023.CrossRefPubMed

24.

Hirsch JD, Steers N, Adler DS, et al. Primary care-based, pharmacist-physician collaborative medication-therapy management of Hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244–54. https://doi.org/10.1016/j.clinthera.2014.06.030.CrossRefPubMedPubMedCentral

25.

Wagner ML, McCarthy C, Bateman MT, Simmons D, Prioli KM. Pharmacists improve Diabetes outcomes: a randomized controlled trial. J Am Pharm Assoc JAPhA. 2022;62(3):775–782e3. https://doi.org/10.1016/j.japh.2021.12.015.CrossRef

26.

Tsuyuki RT, Houle SKD, Charrois TL, et al. Randomized Trial of the Effect of Pharmacist Prescribing on improving blood pressure in the community: the Alberta Clinical Trial in optimizing Hypertension (RxACTION). Circulation. 2015;132(2):93–100. https://doi.org/10.1161/CIRCULATIONAHA.115.015464.CrossRefPubMed

27.

Agency for Healthcare Research and Quality. About Learning Health Systems. Accessed August 1., 2023. https://www.ahrq.gov/learning-health-systems/about.html.

28.

Inker LA, Eneanya ND, Coresh J, et al. New Creatinine- and cystatin C–Based equations to Estimate GFR without Race. N Engl J Med. 2021;385(19):1737–49. https://doi.org/10.1056/NEJMoa2102953.CrossRefPubMedPubMedCentral

29.

Linder JA, Meeker D, Fox CR, et al. Effects of behavioral interventions on Inappropriate Antibiotic Prescribing in Primary Care 12 months after stopping interventions. JAMA. 2017;318(14):1391–2. https://doi.org/10.1001/jama.2017.11152.CrossRefPubMedPubMedCentral

30.

Wallis KA, Andrews A, Henderson M. Swimming against the Tide: Primary Care Physicians’ views on Deprescribing in Everyday Practice. Ann Fam Med. 2017;15(4):341–6. https://doi.org/10.1370/afm.2094.CrossRefPubMedPubMedCentral

Title: Pharmacist-driven outreach initiative to increase prescribing of sodium-glucose cotransporter-2 inhibitors in eligible VHA patients with chronic kidney disease: a study protocol
Authors: Deborah L. Pestka
Daniel Murphy
Pearl Huynh
Jessica A. Rechtzigel
Shari Kjos
Lisa Marie Ellich
Adam N. Kaplan
Brent C. Taylor
Melissa Atwood
Beth A. Polsfuss
Joseph Y. Lee
Areef Ishani
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Chronic Kidney Disease
Published in: BMC Nephrology / Issue 1/2024
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-023-03446-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

Correction: Knockdown of circ-Gatad1 alleviates LPS induced HK2 cell injury via targeting miR-22- 3p/TRPM7 axis in septic acute kidney

Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adults living with chronic kidney disease: the COSMIC study findings

Concordance between muscle mass assessed by bioelectrical impedance analysis and by muscle ultrasound: a cross-sectional study in a cohort of patients on chronic hemodialysis

Evaluating patient perspectives of endovascular created arteriovenous fistulas for dialysis access (EndoAVF)

18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting

Ferroptosis-related genes, a novel therapeutic target for focal segmental glomerulosclerosis

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials