Clinical trial NCT06099808: Veterans Affairs Pharmacist Heart Failure Medication Titration Project 1
Official title: Randomized Evaluation of Audit and Feedback Intervention to Promote Pharmacist Heart Failure Medication Titration in Veterans Affairs Sierra Pacific Network
Study type: INTERVENTIONAL
Overall status: ENROLLING_BY_INVITATION
Phase: NA
Conditions: Heart Failure
Keywords: Pharmacist
Medication therapy
Lead sponsor: Stanford University
Sponsor class: OTHER
Collaborators: name: VA Palo Alto Health Care System
First posted: 2023-10-25
Enrollment: 110
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.


Eligibility criteria: 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

Primary outcomes:
measure: Number of monthly heart failure medication adjustment encounters
timeFrame: 2 months post-randomization to 6 months post-randomization
Secondary outcomes:
measure: Percentage of heart failure patients with medication management by pharmacist
timeFrame: Within 6 months post-randomization
measure: Number of new patients with pharmacist HF management
timeFrame: Within 6 months post-randomization
measure: Guideline medical therapy score
timeFrame: At 6 months post randomization
measure: Beta-blocker therapy
timeFrame: At 6 months post randomization
measure: Renin-angiotensin system inhibitor (RASI) therapy
timeFrame: At 6 months post randomization
measure: Angiotensin receptor neprilysin inhibitor (ARNI) therapy
timeFrame: At 6 months post randomization
measure: Mineralocorticoid receptor antagonist (MRA) therapy
timeFrame: At 6 months post randomization
measure: Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) therapy
timeFrame: At 6 months post randomization
Other outcomes:
Locations:
city: Palo Alto
country: United States
facility: Palo Alto Veteran's Affairs Hospital
state: California
Study officials:
affiliation: Stanford University
name: Paul A Heidenreich, MD, MS
role: PRINCIPAL_INVESTIGATOR
References: