Abstract: SA-PO0467
Pharmacist-Clinician Collaboration to Optimize SGLT2 Inhibitor Prescribing in a Rural Veterans Affairs (VA) Primary Care Clinic: A Quality Improvement Initiative
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Nelson, Laura Elizabeth, University of Iowa Health Care, Iowa City, Iowa, United States
- Seright, Teresa J., US Department of Veterans Affairs, Washington, District of Columbia, United States
- Clausen, Sonja R., US Department of Veterans Affairs, Washington, District of Columbia, United States
- Miller, Karla L., VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
Background
Sodium glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular events and slow chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2DM), cardiovascular disease (CVD), heart failure (HF), or CKD. Despite strong guideline support, uptake has lagged across many practice settings, including rural primary care. In April 2025, only 44.2% of eligible Veterans at a rural VA Community-Based Outpatient Clinic (CBOC) were prescribed an SGLT2i, below the national VA average of ~50%. To address this gap, we launched a 6-month pharmacist–clinician quality improvement initiative.
Methods
We applied a Lean Six Sigma framework among Veterans with T2DM and comorbid CVD, HF, or CKD. Root cause analysis identified three drivers of underutilization: 1) inconsistent EHR identification of eligible patients, 2) provider uncertainty about prescribing thresholds, and 3) absent pharmacist outreach. We deployed a multi-component intervention combining pharmacist–led panel review with proactive outreach, provider education on guidelines, and standardized EHR documentation templates. Monthly prescribing rates were tracked on a statistical process control (SPC) chart.
Results
Of 78 eligible Veterans identified, 55 were contacted by the pharmacist-clinician team and 41 (75%) initiated or reinitiated SGLT2i therapy. The SPC chart demonstrated special-cause variation, with prescribing rising from 44.2% (April 2025) to 71.8% (October 2025), exceeding the national VA average (~50%), reaching the upper control limit, and sustained above the centerline.
Conclusion
A pharmacist–clinician collaborative model meaningfully improved SGLT2i prescribing for high-risk Veterans in a rural VA primary care setting, closing an evidence-to-practice gap in a population with documented prescribing disparities. Next steps will extend this model to other underutilized guideline-directed therapies.
Funding
- Veterans Affairs Support