Opening Doors to Better Care: Initiating and Sustaining Open Access & Medication Titration Clinics
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Oksana Kamneva, PharmD Duke University
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Opening Doors to Better Care: Initiating and Sustaining Open Access & Medication Titration Clinics
- 1. Opening Doors to Better Care: Initiating and Sustaining Open Access & Medication Titration Clinics Oksana Kamneva, PharmD, BCCP, CPP, BCCCP, BCPS Ambulatory Heart Failure Pharmacist Duke Cardiology
- 2. I have no financial conflicts of interest to report relating to the content within this presentation Disclosures
- 3. • Discuss implementation strategies to improve Guideline Directed Medical Therapy (GDMT) utilization in patients with heart failure Objective
- 4. Mebazaa et al. Lancet. 2022 Nov 4;S0140-6736(22)02076-1
- 5. Duke Cardiology Heart Failure Pharmacist GDMT Clinic Oksana Kamneva, PharmD Full-time Ambulatory Heart Failure Pharmacist Erika Nicolsen, PharmD Part-time Ambulatory Heart Failure Pharmacist Jocelyn McAdoo, CPh Pharmacy Technician Patient Assistance Program Coordinator
- 6. Duke Cardiology Heart Failure Pharmacist Referral Process Patient -New HF dx -Frequent hospitalizations Same Day Access – hospital follow up HF Pharmacist Cardiologist 50% 30% 10% 10% Referral source SDA 2F2G MD Inpatient Cardiology
- 7. Duke Cardiology Heart Failure Pharmacist Clinic Actions Referral to HF Pharmacist •Preliminary medication access review Virtual or In- person visit •Start/Titrate GDMT within days of referral and every 1-2 weeks •Continued financial medication assistance •IV iron therapy plans Graduated Patient •Time to max tolerated GDMT is 6-8 weeks •Transition of care
- 8. Duke Cardiology Heart Failure Pharmacist-April 2023- April 10, 2024 384 Referred Patients 89% visits completed virtually 15% no show rate 180 graduated patients 1615 total in- person and virtual pharmacist visits 380 unique distinct patients
- 9. Duke Cardiology Heart Failure Pharmacist-April 2023- April 2024 0 50 100 150 200 250 300 0% 20% 40% 60% 80% 100% 120% 140% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr % of Clinic Capacity % No shows in person Patient Count
- 10. Duke Cardiology Heart Failure Pharmacist Medication Access 77% of HF GDMT clinic referred patients received medication access assistance 48% of patients received copay assistance 400 Patient assistance (PAP) applications
- 11. Duke Cardiology Heart Failure Pharmacist GDMT Utilization- HFrEF 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% BB ACE/ARB/ARNi ARNi MRA SGLT2i Cardiology Other HF APP HF MD HF PharmD 46.9% 48.6% 50.5% 56.7% 82.7% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Cardiology Other HF APP HF MD HF PharmD QuadHFrEF
- 12. Duke Cardiology Heart Failure Pharmacist GDMT Utilization HFpEF/HFmrEF 21.78% 26.09% 30.92% 31.65% 88.71% 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Other HF MD HF APP Cardiology HF PharmD HFpEF/HFmrEF patients on SGLT2i
- 13. Opening Doors to Better Care: Initiating and Sustaining Open Access & Medication Titration Clinics Oksana Kamneva, PharmD, BCCP, CPP, BCCCP, BCPS Ambulatory Heart Failure Pharmacist Duke Cardiology Oksana.Kamneva@duke.edu
Editor's Notes
- Rapid up-titration to 50% optimal doses before discharge, and up-titration of treatments to 100% of recommended doses within 2 weeks following discharge, and 4 scheduled outpatient visits over the 2 months after discharge
- Start/Titrate GDMT within days of referral and every 1 to 2 weeks Communication to referring provider and PCP on max tolerate GDMT doses, follow up ECHO, and ongoing patient assistance needs
- Duke HF Pharmacists April 2023 to April 10th 2024- 1615 total arrived and virtual visits, 380 unique distinct arrived patients, no show rate 15%, 89% visits completed virtually