Abstract: TH-PO1045
Increasing Use of SGLT2 Inhibitors in Patients with CKD and Heart Failure through Physician Education and Outreach Reduces Inpatient Admissions in a Value-Based Care Model
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Kwon, Katherine Westin, Panoramic Health, Tempe, Arizona, United States
- Marcus, Roy G., Panoramic Health, Tempe, Arizona, United States
- Eckhardt, Douglas, Panoramic Health, Tempe, Arizona, United States
- Pu, Jie, Panoramic Health, Tempe, Arizona, United States
- Pardini, Robert, Panoramic Health, Tempe, Arizona, United States
- Vakharia, Nirav, Panoramic Health, Tempe, Arizona, United States
Background
We developed a quality improvement project to increase the uptake of SGLT2i therapy in patients with comorbid chronic kidney disease and heart failure (CKD/HF) participating in a value-based care model with Panoramic Health.
Methods
Patients with CKD/HF and SGLT2i penetration were identified using data from both claims and electronic medical records (EMR). A prescription was defined as at least one prescription written within the past year, or an SGLT2i on the EMR medication list. We then undertook several interventions to increase appropriate prescribing rates. After executing a physician survey to gauge baseline knowledge, we conducted physician education about the efficacy and safety of SGLT2i medications. The Panoramic Health pharmacy team identified patient candidates and notified physicians prior to their next scheduled appointment. Practice-level SGLT2i prescribing rates were reported monthly to practice leaders. Outcomes metrics included SGLT2i prescriptions and inpatient admissions, expressed as admissions per 1000 patients (IP/1K).
Results
The initial rate of SGLT2i utilization in the target population was 16.1%. After five months of the described interventions, rates increased to 24.5% across participating Panoramic Heath partner practices, with some practices achieving rates as high as 50%. All-cause hospital admissions remained, on average, 11% lower (IP/1K of 964 vs. 1070) in patients prescribed an SGLT2i compared to those who were not. This trend persisted as the proportion of patients receiving SGLT2i increased. We also tracked physician responses to pharmacist outreach. 19.7% of messages led to a new prescription. The most common reasons given for not prescribing were “defer to PCP,” “frequent UTIs” and “does not meet criteria.”
Conclusion
SGLT2i prescribing rates are an important metric in any value-based program. While this simple intervention has a near-immediate impact on inpatient admissions, uptake has been slow. Our physician partners responded to education delivered by peers and directed outreach on individual patients. However, therapeutic inertia and concern for potential side effects continue to pose challenges to increased adoption.
Funding
- Commercial Support – AstraZeneca