SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation
| Autor: | Rasha Elhag, Jomol Mathew, Bevin Kathleen Shagoury, Abraham Lin, Renato D. Lopes, Michael A. Fischer, Donna Bartlett, Jane S. Saczynski, Ahmed Nagy, Azraa Amroze, Jacqueline Der, Saud Javed, Sybil L. Crawford, Dinesh Yogaratnam, Kathleen M. Mazor, Fatima Vakil, David D. McManus, Jeffrey M. Ashburner, Siddhartha Narayanan, Alok Kapoor, Eric J. Alper |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Health Knowledge Attitudes Practice medicine.medical_specialty Time Factors Attitude of Health Personnel medicine.drug_class Reminder Systems Clinical Decision-Making Psychological intervention Administration Oral 030204 cardiovascular system & hematology Medical Order Entry Systems Decision Support Techniques law.invention Academic detailing 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Risk Factors law Atrial Fibrillation Ambulatory Care Electronic Health Records Humans Medicine Profiling (information science) In patient 030212 general & internal medicine Practice Patterns Physicians' Intensive care medicine Aged Electronic Mail business.industry Patient Selection Anticoagulant Anticoagulants Atrial fibrillation Middle Aged medicine.disease Drug Utilization Stroke Treatment Outcome Massachusetts Oral anticoagulant Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation: Cardiovascular Quality and Outcomes. 13 |
| ISSN: | 1941-7705 1941-7713 |
| DOI: | 10.1161/circoutcomes.119.005871 |
| Popis: | Background: Previous provider-directed electronic messaging interventions have not by themselves improved anticoagulation use in patients with atrial fibrillation. Direct engagement with providers using academic detailing coupled with electronic messaging may overcome the limitations of the prior interventions. Methods and Results: We randomized outpatient providers affiliated with our health system in a 2.5:1 ratio to our electronic profiling/messaging combined with academic detailing intervention. In the intervention, we emailed providers monthly reports of their anticoagulation percentage relative to peers for atrial fibrillation patients with elevated stroke risk (CHA 2 DS 2 -VASc ≥2). We also sent electronic medical record-based messages shortly before an appointment with an anticoagulation-eligible but untreated atrial fibrillation patient. Providers had the option to send responses with explanations for prescribing decisions. We also offered to meet with intervention providers using an academic detailing approach developed based on knowledge gaps discussed in provider focus groups. To assess feasibility, we tracked provider review of our messages. To assess effectiveness, we measured the change in anticoagulation for patients of intervention providers relative to controls. We identified 85 intervention and 34 control providers taking care of 3591 and 1908 patients, respectively; 33 intervention providers participated in academic detailing. More than 80% of intervention providers read our emails, and 98% of the time a provider reviewed our in-basket messages. Replies to messages identified patient refusal as the most common reason for patients not being on anticoagulation (11.2%). For the group of patients not on anticoagulation at baseline assigned to an intervention versus control provider, the adjusted percent increase in the use of anticoagulation over 6 months was 5.2% versus 7.4%, respectively ( P =0.21). Conclusions: Our electronic messaging and academic detailing intervention was feasible but did not increase anticoagulation use. Patient-directed interventions or provider interventions targeting patients declining anticoagulation may be necessary to raise the rate of anticoagulation. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT03583008. |
| Databáze: | OpenAIRE |
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