The proposed study is an effectiveness-implementation hybrid type II trial designed to evaluate the impact of provider- and patient-directed interventions on FDC use. The trial will test the effectiveness of theory-driven nudges tailored to address provider and patient barriers. All interventions will be pharmacist-driven, with pharmacists delivering information via nudges to providers and via nudges or more intensive interventions (i.e., CPA) to patients. Data to evaluate outcomes will be extracted from electronic health records.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
720
Pharmacists will deliver targeted nudges to providers through clinical decision support integrated into the electronic health record (EHR)
Patients will receive pharmacist-delivered nudges (e.g., text messages) 1-7 days before their visit to encourage fixed-dosed combinations
Patients will receive pharmacist counseling and prescribing delivered via virtual encounters after their visit
Change in systolic blood pressure
Data for this outcome will be extracted from electronic health records. The primary effectiveness outcome will be a change in ambulatory systolic blood pressure at 3 months. For patients who do not return within 3 months, their index visit reading will be carried forward.
Time frame: 6 months
Change in diastolic blood pressure
Change in diastolic blood pressure from qualifying visit blood pressure reading to the end of the 6-month follow-up, using EHR data
Time frame: 6 months
Percentage of patients with well-controlled blood pressure
Percentage of patients who reach blood pressure control defined as \<140/90mmHg
Time frame: 6 months
PCP level adoption: FDC prescribing; FDC discussion in EHR notes
Percentage of patients whose PCPs prescribe FDC within 6 months; any intensification at 6 months will also be explored; any FDC documentation in the notes
Time frame: 6 months
Patient level adoption: FDC adherence (fill)
Percentage of patients who fill their first FDC prescription within 6 months; filling any intensified prescription within 6 months will also be explored.
Time frame: 6 months
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