Abstract: SA-PO0533
Barriers and Facilitators to SGLT2 Inhibitor Use for CKD in Primary Care: Insights from a Veterans Health Administration Rural Community of Practice
Session Information
- CKD: Clinical - Therapies, CKM Health, Special Populations, and More
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Good, Mary K., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Seright, Teresa J., VA Montana Healthcare System, Fort Harrison, Montana, United States
- Hale-Gallardo, Jennifer, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
- Miller, Karla L., University of Utah Health Hospitals and Clinics, Salt Lake City, Utah, United States
- Griffin, Benjamin R., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Yamada, Masaaki, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Reisinger, Heather, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
- Swee, Melissa L., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) slow kidney disease progression and reduce cardiovascular events in patients with chronic kidney disease (CKD). However, adoption of SGLT2i in routine clinical practice has been suboptimal, with <15% of eligible patients with CKD prescribed[MS1] . We explored barriers and facilitators to prescribing SGLT2i in the Veterans Health Administration (VHA), one of the largest healthcare systems in the US.
Methods
Two facilitated group discussions were conducted following presentations on SGLT2i initiatives in rural VHA clinics as part of the VHA Rural Health Community of Practice, a national virtual learning collaborative for clinicians. Questions covered current SGLT2i use, prescribing barriers, initiation and monitoring, perceived patient concerns, and support resources. Audio and text-chat responses were captured and analyzed using a rapid qualitative approach with inductive and deductive thematic coding guided by the RE-AIM framework.
Results
Discussion groups (N=65 and N=64) included primary care clinicians, nephrologists, pharmacists, and other healthcare professionals from 79 VA facilities. Knowledge gaps, misconceptions (e.g. misinterpretation of expected initial eGFR decline), and lingering early safety concerns caused hesitation to prescribe among some clinicians. Workflow barriers included laboratory follow-up, rural patients’ medication access, and limited visit time. Figure 1 shows all themes derived from the data and strategies to support prescribing.
Conclusion
Clinicians described persistent barriers to SGLT2i prescribing and actionable facilitators. Targeted clinician education, patient counseling tools, workflow support, and team coordination may improve uptake of SGLT2i and improve outcomes in CKD.
Funding
- Veterans Affairs Support