SUPPORT-AF II: Supporting Use of Anticoagulants Through Provider Profiling of Oral Anticoagulant Therapy for Atrial Fibrillation
Year: 2020
Type: article
Study design: Clinical Trial
Abstract: 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.
Authors: Alok Kapoor, Azraa Amroze, Fatima Vakil, Sybil Crawford, Jacqueline Der, Jomol Mathew, Eric Alper, Dinesh Yogaratnam, Saud Javed, Rasha Elhag, Abraham Lin, Siddhartha Narayanan, Donna Bartlett, Ahmed Nagy, Bevin Kathleen Shagoury, Michael A. Fischer, Kathleen M. Mazor, Jane S. Saczynski, Jeffrey M. Ashburner, Renato Lopes, David D. McManus
Institutions: UMass Memorial Health Care, University of Massachusetts Chan Medical School, Reliant Medical Group, UMass Memorial Medical Center, Nationwide Children's Hospital, Abigail Wexner Research Institute, Northeastern University, Massachusetts College of Pharmacy and Health Sciences, Brigham and Women's Hospital, Massachusetts General Hospital, Duke Clinical Research Institute
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W3007651759