Optimizing SGLT2 inhibitor and GLP-1 RA prescribing in high-risk patients with diabetes: a Department of Veterans Affairs quality improvement intervention.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Shira Yun, Kathryn Hurren, Rob Holleman, Mandi Klamerus, Adam Tremblay, Jeremy B Sussman
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引用次数: 0

Abstract

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 (SGLT2) inhibitors have dramatic clinical benefits, but many appropriate patients do not receive them. We developed a quality improvement (QI) intervention to increase the adoption of these drugs in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and/or heart failure (HF). The purpose of this study was to examine whether the intervention increased the use of SGLT2 inhibitors and GLP-1 RAs.

Methods: The intervention included: (1) education, academic detailing (1:1 pharmacist to clinician coaching), and audit and feedback directed at providers and allied health professionals at the Veterans Affairs Ann Arbor Healthcare System (VAAAHS); (2) outreach and inreach to patients with T2D and ASCVD, CKD, and/or HF who were not on GLP-1 RAs or SGLT2 inhibitors at baseline. Patients were identified and outcomes evaluated using existing VA national reports. We performed a difference-in-difference analysis of the change in GLP-1 RA and SGLT2 inhibitor prescribing rates before, during, and after the intervention, comparing rates in VAAAHS to rates in the same VA region (called a Veterans Integrated Service Network (VISN)) and the VA nationally to determine whether the rates of prescribing increased faster in VAAAHS than the VISN or VA nationally.

Results: Home telehealth nurses and clinical pharmacy practitioners (CPPs) provided outreach to 445 patients; 48% (n = 215) of whom initiated SGLT2 inhibitors or GLP-1 RAs. Four CPPs provided 101 academic detailing sessions to 72 providers. Prior to the intervention, the prescribing rate was 22.7% in VAAAHS, 20.3% in the VISN 10 region, and 18.7% in VA nationally. At the end of the 12-month intervention, the prescribing rate had increased to 37.9% in VAAAHS, 28.4% in the VISN 10 region, and 26.5% in VA nationally. Six-months post-intervention, the prescribing rate continued to increase to 42.4% in VAAAHS, 32.2% in the VISN 10 region, and 30.2% in VA nationally. The rate of prescribing growth in VAAAHS was significantly faster than in the VISN or VA nationally (p < 0.001).

Conclusion: Our multidisciplinary QI intervention increased SGLT2 inhibitor and GLP-1 RA prescribing approximately 8% points faster than the national average.

优化高危糖尿病患者的SGLT2抑制剂和GLP-1 RA处方:退伍军人事务部质量改善干预
胰高血糖素样肽-1受体激动剂(GLP-1 RA)和葡萄糖共转运蛋白-2钠(SGLT2)抑制剂具有显著的临床益处,但许多合适的患者没有接受它们。我们开发了一种质量改善(QI)干预,以增加2型糖尿病(T2D)、动脉粥样硬化性心血管疾病(ASCVD)、慢性肾脏疾病(CKD)和/或心力衰竭(HF)患者对这些药物的采用。本研究的目的是研究干预是否增加了SGLT2抑制剂和GLP-1 RAs的使用。方法:干预包括:(1)教育、学术详细介绍(1:1药剂师对临床医生的指导)、针对安娜堡退伍军人事务医疗保健系统(VAAAHS)的提供者和专职卫生专业人员的审计和反馈;(2)扩大和延伸到T2D和ASCVD、CKD和/或HF患者,这些患者在基线时没有使用GLP-1 RAs或SGLT2抑制剂。使用现有VA国家报告确定患者并评估结果。我们对干预前、干预期间和干预后GLP-1 RA和SGLT2抑制剂处方率的变化进行了差异分析,将VAAAHS的处方率与同一VA地区(称为退伍军人综合服务网络(VISN))和全国VA的处方率进行了比较,以确定VAAAHS的处方率是否比全国的VISN或VA增加得更快。结果:家庭远程医疗护士和临床药学从业人员(CPPs)为445例患者提供外展服务;其中48%(215)的患者启动了SGLT2抑制剂或GLP-1 RAs。四个cpp为72个提供者提供了101个学术详细会议。干预前,全国VAAAHS的处方率为22.7%,VISN 10地区为20.3%,VA为18.7%。在12个月的干预结束时,全国VAAAHS的处方率增加到37.9%,VISN 10地区的处方率增加到28.4%,VA的处方率增加到26.5%。干预6个月后,全国VAAAHS的处方率继续上升至42.4%,VISN 10地区为32.2%,VA为30.2%。结论:我们的多学科QI干预增加了SGLT2抑制剂和GLP-1 RA的处方,比全国平均水平快了约8%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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