Methods, rationale, and design for a remote pharmacist and navigator-driven disease management program to improve guideline-directed medical therapy in patients with type 2 diabetes at elevated cardiovascular and/or kidney risk.

Abstract

AIM:

Describe the rationale for and design of Diabetes Remote Intervention to improVe use of Evidence-based medications (DRIVE), a remote medication management program designed to initiate and titrate guideline-directed medical therapy (GDMT) in patients with type 2 diabetes (T2D) at elevated cardiovascular (CV) and/or kidney risk by leveraging non-physician providers.

METHODS:

An electronic health record based algorithm is used to identify patients with T2D and either established atherosclerotic CV disease (ASCVD), high risk for ASCVD, chronic kidney disease, and/or heart failure within our health system. Patients are invited to participate and randomly assigned to either simultaneous education and medication management, or a period of education prior to medication management. Patient navigators (trained, non-licensed staff) are the primary points of contact while a pharmacist or nurse practitioner reviews and authorizes each medication initiation and titration under an institution-approved collaborative drug therapy management protocol with supervision from a cardiologist and/or endocrinologist. Patient engagement is managed through software to support communication, automation, workflow, and standardization.

CONCLUSION:

We are testing a remote, navigator-driven, pharmacist-led, and physician-overseen management strategy to optimize GDMT for T2D as a population-level strategy to close the gap between guidelines and clinical practice for patients with T2D at elevated CV and/or kidney risk.

• Authors: Alexander J Blood, Lee-Shing Chang, Caitlin Colling, Gretchen Stern, Daniel Gabovitch, Guinevere Feldman, Asma Adan, Fanta Waterman, Emily Durden, Carol Hamersky, Joshua Noone, Samuel J Aronson, Paul Liberatore, Thomas A Gaziano, Lina S Matta, Jorge Plutzky, Christopher P Cannon, Deborah J Wexler, Benjamin M Scirica
• Journal: Primary care diabetes (Prim Care Diabetes) Vol. 18 Issue 2 Pg. 202-209 (04 2024) ISSN: 1878-0210 [Electronic] England
• PMID: 38302335 (Publication Type: Randomized Controlled Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Topics

• Humans
• Diabetes Mellitus, Type 2 (diagnosis, drug therapy)
• Pharmacists
• Kidney
• Renal Insufficiency, Chronic (diagnosis)
• Disease Management
• Cardiovascular Diseases (diagnosis, epidemiology, etiology)