Veterans Affairs Pharmacist Heart Failure Medication Titration Project 1

Heart Failure Clinical Trial

Official title:

Randomized Evaluation of Audit and Feedback Intervention to Promote Pharmacist Heart Failure Medication Titration in Veterans Affairs Sierra Pacific Network

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT06099808
• Other study ID #: 72662
• Status: Enrolling by invitation
• Phase: N/A
• Start date: November 20, 2023
• Est. completion date: September 30, 2024

Study information

• Verified date: April 2024
• Source: Stanford University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 110
• Est. completion date: September 30, 2024
• Est. primary completion date: June 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

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

Related Conditions & MeSH terms

• Heart Failure

Intervention

Other:
• Audit and Feedback Emails
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.
• Patient Specific Targets
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.
• Educational Resources
Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Locations

Country	Name	City	State
United States	Palo Alto Veteran's Affairs Hospital	Palo Alto	California

Sponsors (2)

Lead Sponsor	Collaborator
Stanford University	VA Palo Alto Health Care System

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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	Percentage of heart failure patients with medication management by pharmacist	For each pharmacist, will calculate the percentage of patients with heart failure in their panel that receive medication adjustments from pharmacist	Within 6 months post-randomization
Secondary	Number of new patients with pharmacist HF management	For each pharmacist, will calculate the number of patients with heart failure in their panel that receive care from pharmacist that were not receiving care prior to randomization	Within 6 months post-randomization
Secondary	Guideline medical therapy score	Composite score of heart failure medical therapy among patients with heart failure for patients within each pharmacists panel	At 6 months post randomization
Secondary	Beta-blocker therapy	Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with beta-blocker therapy	At 6 months post randomization
Secondary	Renin-angiotensin system inhibitor (RASI) therapy	Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with RASI therapy	At 6 months post randomization
Secondary	Angiotensin receptor neprilysin inhibitor (ARNI) therapy	Percentage of patients with heart failure with reduced ejection fraction in each pharmacist panel that are treated with ARNI therapy	At 6 months post randomization
Secondary	Mineralocorticoid receptor antagonist (MRA) therapy	Percentage of patients with heart failure in each pharmacist panel that are treated with MRA therapy	At 6 months post randomization
Secondary	Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) therapy	Percentage of patients with heart failure in each pharmacist panel that are treated with SGLT2i therapy	At 6 months post randomization