Abstract: TH-PO1026
ACEi/Angiotensin Receptor Blocker (ARB) Prescribing Practices and Patient Experiences in CKD: A Qualitative Study of Clinicians and Patients
Session Information
- CKD Epidemiology, Risk Factors, Prevention - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
- Arney, Jennifer, University of Houston Clear Lake, Houston, Texas, United States
- Wydermyer, Sheena R., Michael E DeBakey VA Medical Center, Houston, Texas, United States
- Herrera, Michael Alexander, Baylor College of Medicine, Houston, Texas, United States
- Richardson, Peter, Michael E DeBakey VA Medical Center, Houston, Texas, United States
- Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Akeroyd, Julia, Baylor College of Medicine, Houston, Texas, United States
- Gobbel, Glenn T., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Virani, Salim S., The Aga Khan University, Karachi, Sindh, Pakistan
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background
Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) improve clinical outcomes but are underutilized in chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications, which contributes to underutilization.
Methods
We conducted in-depth interviews with a multi-profession sample of clinicians and patients with documented ACEi/ARB side effects in the past 6 months. Participants were recruited from 2 Veterans Affairs (VA) healthcare systems. We used inductive and deductive qualitative data analysis approaches to identify themes related to experiences with ACEi/ARB. Thematic analysis focused on prescribing decisions and practices, clinical guidelines, and perception of side effects. Data were analyzed as they amassed. Recruitment was stopped at the point of thematic saturation.
Results
Participants included 15 clinicians (primary care, geriatrics, cardiology, and endocrinology; 8 physicians, 3 NPs/PAs, 4 clinical pharmacists) and 10 patients (mean age 69 years, 40% men). Clinicians prescribe ACEi/ARB for blood pressure control and kidney protection, and many emphasized the role these agents play in diabetes management. Clinicians described providing comprehensive patient education about CKD and ACEi/ARB. However, patient interviews revealed knowledge gaps about CKD and the need for ACEi/ARB, with many patients unaware of their CKD diagnosis or why they had been prescribed ACEi/ARB. Clinicians’ drug management strategies and understanding of prescribing guidelines varied widely. They identified structural and patient-level barriers to prescribing, and many endorsed the development of a decision support tool to facilitate ACEi/ARB prescribing and management (Figure).
Conclusion
Our qualitative exploration of clinicians’ and patients’ experiences with ACEi/ARB will inform the development of a decision support tool to improve prescription rates of these agents for patients with CKD.
Funding
- Veterans Affairs Support