Veterans Affairs Pharmacist Heart Failure Medication Titration Project 1

NCT ID: NCT06099808

Last Updated: 2024-04-17

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 110 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-11-20
• Study Completion Date: 2024-09-30

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.

Conditions

Heart Failure

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Audit and Feedback (AF)

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.

Group Type: EXPERIMENTAL

Audit and Feedback Emails

Intervention Type: OTHER

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.

Educational Resources

Intervention Type: OTHER

Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Audit and Feedback with Patient Specific Targets (AF+)

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.

Group Type: EXPERIMENTAL

Audit and Feedback Emails

Intervention Type: OTHER

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

Intervention Type: OTHER

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

Intervention Type: OTHER

Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Usual Care

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.

Group Type: ACTIVE_COMPARATOR

Educational Resources

Intervention Type: OTHER

Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Interventions

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.

Intervention Type: OTHER

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.

Intervention Type: OTHER

Educational Resources

Monthly educational webinars on pharmacist HF management and access to material and protocols on HF medication management.

Intervention Type: OTHER

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

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

VA Palo Alto Health Care System

FED

Sponsor Role: collaborator

Stanford University

OTHER

Sponsor Role: lead

Responsible Party

Paul A. Heidenreich

Professor of Medicine

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Paul A Heidenreich, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Stanford University

Locations

Palo Alto Veteran's Affairs Hospital

Palo Alto, California, United States

Countries

United States

Other Identifiers

72662

Identifier Type: -

Identifier Source: org_study_id