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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number14
JournalBMC Nephrology
Volume25
Issue number1
DOIs
StatePublished - Dec 2024

Bibliographical note

Publisher Copyright:
© 2024, This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

Keywords

  • Chronic Kidney Disease
  • Clinical pharmacy services
  • Implementation strategy

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