Pharmacist-driven outreach initiative to increase prescribing of sodium-glucose cotransporter-2 inhibitors in eligible VHA patients with chronic kidney disease: a study protocol

• Published in: BMC nephrology 2024-01, Vol.25 (1), p.14-14, Article 14
• Main Authors: Pestka, Deborah L, Murphy, Daniel, Huynh, Pearl, Rechtzigel, Jessica A, Kjos, Shari, Ellich, Lisa Marie, Kaplan, Adam N, Taylor, Brent C, Atwood, Melissa, Polsfuss, Beth A, Lee, Joseph Y, Ishani, Areef
• Format: Article
• Language: English
• Subjects: Chronic Kidney Disease; Chronic kidney failure; Clinical pharmacy services; Complications and side effects; Demographic aspects; Dextrose; Diabetes; Diabetes mellitus (non-insulin dependent); Dosage and administration; Drug stores; Drug therapy; Electronic health records; Evaluation; Glucose; Health aspects; Health care reform; Hypoglycemic agents; Implementation strategy; Intervention; Kidney diseases; Management; Medical research; Medicine, Experimental; Patient compliance; Patients; Pharmaceutical services; Pharmacists; Practice guidelines (Medicine); Prescription writing; Primary care; Regulatory approval; Social security numbers; Sodium-glucose cotransporter; Testing; Type 2 diabetes; Veterans
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-023-03446-1

Patients with chronic kidney disease (CKD) are at increased risk for multiple adverse events, several of which have been proven to be less likely with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). As a result, guidelines now recommend SGLT2i be given to those with mild to moderate CKD and type 2 diabetes. The objective of this study is to evaluate if a pharmacist-driven SGLT2i prescribing initiative among eligible patients with CKD and diabetes within the VA could more rapidly improve the adoption of SGLT2i via a pragmatic approach aligned with learning health systems. Eligible patients will be identified through an established VA diabetes dashboard. Veterans with an odd social security number (SSN), which is effectively a random number, will be the intervention group. Those with even SSNs will serve as the control while awaiting a second iteration of the same interventional program. The intervention will be implemented in a rolling fashion across one Veterans Integrated Service Network. Our primary outcome is initiation of an SGLT2i. Secondary outcomes will include medication adherence and safety-related outcomes. This project tests the impact of a pharmacist-driven medication outreach initiative as a strategy to accelerate initiation of SGLT2i. The results of this work will not only illustrate the effectiveness of this strategy for SGLT2is but may also have implications for increasing other guideline-concordant care. Furthermore, the utilization of SSNs to select Veterans for the first wave of this program has created a pseudo-randomized interventional trial supporting a pragmatic learning health system approach. ISRCTN12374636.