Veterans Affairs Pharmacist Heart Failure Medication Titration Project 1

Study Overview
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Brief Summary
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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.

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

Conditions
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Heart Failure

Intervention / Treatment
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* Other: Audit and Feedback Emails
* Other: Patient Specific Targets
* Other: Educational Resources


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Audit and Feedback (AF)<br>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<br>* 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.<br>Other: Educational Resources<br>* Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.<br>|
| Experimental: Audit and Feedback with Patient Specific Targets (AF+)<br>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<br>* 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.<br>Other: Patient Specific Targets<br>* 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.<br>Other: Educational Resources<br>* Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.<br>|
| Active Comparator: Usual Care<br>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<br>* Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| 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 | 
| 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 | 
| 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 | 
| 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 | 
| 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 | 
| 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 | 
| 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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pharmacist, Medication therapy