Implementation of a Pharmacist-Led Service to Expand SGLT2 Inhibitor Use Beyond Diabetes in the Primary Care Setting

The purpose of this report is to evaluate the impact of a pharmacist-led quality improvement initiative on the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with chronic kidney disease (CKD) and heart failure (HF) at a primary care clinic.

As part of a pharmacist-led quality improvement initiative between March 1, 2022, and March 1, 2023, patients with CKD and HF were considered for SGLT2 inhibitor therapy by a primary care provider or referred to the pharmacy team for potential initiation of treatment using a collaborative practice agreement. The pharmacy team was led by a diabetes care and education specialist (DCES) who regularly manages drug therapy, including SGLT2 inhibitors, for people with diabetes. Predefined criteria for appropriate SGLT2 inhibitor use in patients with CKD and HF was developed to identify eligible patients. The primary outcome of this initiative was the change in the proportion of patients appropriately receiving SGLT2 inhibitor therapy.

A total of 71 patients met treatment criteria. Of the 71 patients identified, 57 were not receiving treatment at baseline. By the end of the initiative, the proportion of patients receiving SGLT2 inhibitor therapy increased from 19.7% to 50.7%. Treatment was initiated by the pharmacist in 64% of patients.

This initiative resulted in a significant improvement in SGLT2 inhibitor use for patients with CKD and HF. The findings highlight the feasibility of using DCES-credentialed pharmacists in an interprofessional care team to initiate SGLT2 inhibitor therapy for patients with these conditions in the primary care setting.