Category: Federal Forum Posters
Purpose: Reducing hemoglobin A1c can prevent microvascular complications, but it can also increase the risk for hypoglycemia. The Veterans Affairs Hypoglycemia Safety Initiative (HSI) was established to develop an electronic medical record tool to identify diabetic patients at high risk for hypoglycemia. The purpose of this study is to evaluate the implementation of this tool at the VA Eastern Colorado Health Care System (VAECHCS) by analyzing the types of interventions pharmacists made after reviewing these patients’ profiles, and to assess opportunities for practice change in our hypoglycemia population health management strategies.
Methods: This study will be submitted to the Institutional Review Board for approval. Automatic monthly reports, generated and stored securely within the VA Corporate Data Warehouse website, will identify patients at high risk for hypoglycemia for the HSI tool. Qualifying patients must have a hemoglobin A1c (A1c) less than 7 percent and an active prescription for insulin and/or a sulfonylurea and one of the following: age 75 years or older, serum creatinine (SCr) greater than 1.7 mg/dL, or cognitive impairment or dementia. Data regarding patient age, A1c, SCr, pertinent outpatient medications, and past medical history pertaining to diabetes will be collected. A manual chart review of pharmacist chronic disease management notes and primary care provider notes will be performed to determine the frequency of pharmacist interventions to reduce hypoglycemia risk. Additionally, the types of pharmacist interventions will be analyzed, including relaxing the A1c goal, reducing insulin and/or sulfonylurea doses, patient education (i.e. proper insulin administration, hypoglycemia treatment), ordering glucagon kits, and others. A1c before and after pharmacist review and specified A1c goals will also be evaluated. Upon completion, all data will de-identified, entered in a password-protected spreadsheet, and stored within a secure hard drive with access limited to the study investigators.
Results: Not applicable
Conclusion: Not applicable
Vivian Cheng– Pharm.D. Candidate, UNC Eshelman School of Pharmacy, Greenville, NC