University of Minnesota
This pilot study will evaluate the feasibility of using a clinical decision support(CDS) message to support consideration of SGLT2 inhibitor prescribing in patients with type 2 diabetes who recently had acute kidney injury. Participating M Health Fairview primary care clinics will be randomized to either receive the clinical decision support intervention or continue usual care. In intervention clinics, providers or clinic pharmacists will receive a message before a scheduled encounter with an eligible patient. The message is intended to support clinical decision-making about SGLT2 inhibitor use, but prescribing decisions will remain with the patient's usual clinical care team. The study will assess feasibility outcomes, including identification of eligible patients, delivery of clinical decision support (CDS) messages, provider/pharmacist receipt of CDS messages, SGLT2i consideration, SGLT2i prescribing, and availability of follow-up kidney function data in the electronic health record.
Sodium-glucose co-transporter-2 inhibitors are FDA-approved medications for type 2 diabetes and have been shown to reduce kidney and cardiovascular risks in several patient populations. However, providers may be hesitant to prescribe SGLT2 inhibitors to patients who have recently experienced acute kidney injury because of concerns about kidney function changes after initiation. This study is a pilot adaptive cluster randomized clinical trial conducted in participating M Health Fairview primary care clinics. Clinics will be randomized 1:1 to receive a clinical decision support intervention or…
Inclusion Criteria for Providers and Pharmacists: * Assigned to work in a primary care specialty as a medical provider or assigned to work as a clinic pharmacist * Assigned to work in one of the participating study clinics Inclusion Criteria for Patients: * Scheduled to be seen in a participating clinic with a physician or advanced practice provider in a primary care specialty or a clinic pharmacist * Medical history of acute kidney injury during a hospitalization with discharge within 1 year before the scheduled appointment * Medical history of type 2 diabetes mellitus (by billing code) *…
The clinical decision support intervention is a message sent to primary care providers or clinic pharmacists before a scheduled encounter with an eligible patient. The message provides key information to support consideration of SGLT2i prescribing in patients with type 2 diabetes and recent acute kidney injury. The study team will not provide study medication, and prescribing decisions will remain with the usual clinical care team.
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