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Implementation and Evaluation of Pharmacist-Based Management of Chronic Heart Failure for Rural Veterans

Principal Investigators

Palo Alto Veterans Affairs Healthcare System; Stanford University

  • Assistant Professor of Medicine, Cardiovascular Medicine
  • Stanford Prevention Research Center

Palo Alto Veterans Affairs Healthcare System; Stanford University

  • Chief of Medicine, Palo Alto VA
  • Professor of Medicine, Cardiovascular Medicine

PHARM-HF Project Aims

Aim 1: Identify patient, neighborhood, and facility characteristics associated with less GDMT up titration for rural patients with HF. Using national VHA and Medicare data, we will identify the subset of rural HF patients at highest risk of sub-optimal GDMT based on a composite GDMT score.15 We will target this cohort with subsequent efforts to improve GDMT. Hypothesis: Rural patients living furthest from cardiologists and those living in neighborhoods with lower educational attainment have a lower composite GMDT score.

Aim 2: Test a novel, equity-focused, audit-and-feedback implementation strategy to increase uptake of pharmacist HF management among rural patients. Our equity-based strategy will focus on increasing pharmacist management among rural HF patients with poor access to care. Our mixed methods evaluation will compare uptake of the pharmacist program in 4 VHA intervention regions with 14 control regions and identify barriers and facilitators to increasing pharmacist management. Hypothesis: The 4 VHA regions with an equity-focused implementation strategy will have more rural HF patients managed by pharmacists than the 14 VHA regions without this dedicated implementation strategy.

Aim 3: Test a mobile health tool to promote patient engagement in the HF pharmacist program and evaluate its effect on HF GDMT rates. Applying human-centered design principles, we will design a mobile health tool for rural Veterans. We will evaluate whether this mobile health intervention tool the effect of pharmacist management on GDMT rates in a cluster-randomized trial (randomized by clinic) that is nested within our implementation study (Aim 2). Hypothesis: Combining pharmacist HF management with a tool designed to improve patient HF engagement and knowledge leads to a higher GDMT score compared with pharmacist management alone.

Project Trainees