Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: More than 90% of patients with heart failure and reduced ejection fraction (HFrEF) are not prescribed recommended medications. Current challenges to optimal prescribing include: (a) misconceptions, unfamiliarity, or discomfort in applying guidelines/evidence, (b) clinical inertia, (c) multilevel competing priorities, and (d) insufficient availability and timeliness of reliable patient data and monitoring.
Research Question or Hypothesis: To identify possible solutions to strategically address current challenges to prescribing evidence based HFrEF medications (i.e., beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors, sodium/glucose cotransport 2 inhibitors, mineralocorticoid receptor antagonists).
Study Design: Qualitative study using content analysis methodology and semi-structured interviews followed by member checking.
Methods: We used purposeful sampling and conducted semi-structured interviews of primary care and cardiology clinicians via video teleconference (Zoom) between December 2020 and February 2021. After discussing prescribing challenges, participants discussed potential solutions. Participants were invited to participate in member checking focus groups to establish credibility of the preliminary interview findings. All sessions were recorded and professionally transcribed verbatim. An inductive coding and analysis process was used to develop a codebook and apply it to the transcripts.
Results: We interviewed 33 clinicians (13 cardiology) and did member checking with 10. Six themes of solutions were identified: 1) comanagement, 2) education strategies, 3) explicit risk vs. benefit data, 4) patient engagement, 5) policy changes, and 6) data integration, summary, and sharing. Each theme was further characterized by explicit examples. Participants noted many new technological solutions to address these themes, including enhanced EHR integration, creation of novel alerts, and incorporation of patient wearable device data with EHR data.
Conclusion: Our findings suggest clinicians want expanded use of technology and automation to augment existing approaches to address challenges to prescribing HFrEF medications. The findings from this study can be used to strategically design interventions to improve prescribing of chronic medications for HFrEF.
Presenting Author
Aracely Sosa BSUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Authors
Katy Trinkley PharmD,PhD