A system approach to improving guideline-directed therapy for cardio-renal-metabolic conditions: The “beyond diabetes” initiative

Despite demonstrating improvements in cardiovascular disease, kidney disease, and survival outcomes, guideline-directed antihyperglycemic medications such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1-RA), are underutilized. Many obstacles...

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Bibliographic Details
Published in:American journal of preventive cardiology 2023-12, Vol.16, p.100608-100608, Article 100608
Main Authors: Hirsh, Benjamin J., Hirsch, Jamie S., Hmoud, Hosam, Weintraub, Spencer, Cha, Agnes, Lesser, Martin, Huang, Xueqi, Xie, Yan Yan Sally, Nahrwold, Rachel, Joshua, John, Scanlon, Jennifer, Galella, Thomas, Singh, Varinder, Gianos, Eugenia
Format: Article
Language:English
Subjects:
Cardiovascular
Diabetes mellitus
Electronic health record
Guideline-directed
Initiative
Kidney
Original Research Contribution
Outcomes
Pharmacy
Preventive medicine
Systems-based
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Summary:Despite demonstrating improvements in cardiovascular disease, kidney disease, and survival outcomes, guideline-directed antihyperglycemic medications such as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1-RA), are underutilized. Many obstacles constrain their use including lack of systematic provider and patient education, concern for medication side effects, and patient affordability. We designed a multimodality, systems-based approach to address these challenges with the goal of increasing medication utilization across the largest healthcare system in New York State. This multispecialty collaborative included provider and patient education, an electronic health record-enabled platform to identify eligible patients, and access to pharmacists for medication guidance and addressing insurance coverage barriers. Surveys were administered following grand rounds lectures and knowledge-based questionnaires were given before and after case-based sessions for housestaff, with results analyzed using a two-sided Student's t-test. Rates of first prescriptions of SGLT2i/GLP1-RA in combined and individual analyses were compared between the pre- and post-education periods (6 months prior to 3/31/2021 and 6 months post 8/19/2021), and the change in prescriptions per 100 eligible-visits was assessed using the incidence density approach. Among grand rounds participants, 69.3% of respondents said they would make changes to their clinical practice. Knowledge increased by 14.7% (p-value
ISSN:2666-6677
2666-6677
DOI:10.1016/j.ajpc.2023.100608