Table 3.
Quantitative endpoints.
| Endpoint | Overall n/N, % (95% CI) | Clinician-level interventions |
Patient-level interventions |
||||
|---|---|---|---|---|---|---|---|
| CN n/N (%) | CN+NF n/N (%) | Odds ratio (95% CI)a | Usual care n/N (%) | Patient activation n/N (%) | Odds ratio (95% CI)a | ||
| Primary endpoint | |||||||
| Completion of week 5 assessment | 35/47, 74.5 (58.6, 85.7) | 15/24 (62.5) | 20/23 (87.0) | 4.03 (1.03,15.72) | 19/26 (73.1) | 16/21 (76.2) | 1.24 (0.12, 12.73) |
| Secondary endpoint | |||||||
| Receipt of both assigned interventions | 47/47, 100 (-c) | 24/24 (100) | 23/23 (100) | -c | 26/26 (100) | 21/21 (100) | -c |
| Exploratory endpoints | |||||||
| Initiation of either a PPI or discontinuation of all antiplatelet therapy at week 5 as determined by patient interview (Note: denominator is restricted to patients who completed week 5 assessment and reported using an antiplatelet medication at baseline without a PPI, n = 29) | 11/29, 37.9 (16.9, 64.7) | 4/11 (36.4) | 7/18 (38.9) | 0.91 (0.13, 6.3) | 7/18 (38.9) | 4/11 (36.4) | 1.10 (0.24, 5.1) |
| Intervention fidelity, defined as receipt of intervention strategies as assigned within the appropriate week and with the correct clinician recipient | 47/47, 100 (1, 1) | 24/24 (100) | 23/23 (100) | -c | 26/26 (100) | 21/21 (100) | -c |
| Patients reached by phone within 3 attempts at week 5 | 37/47, 78.7 (64.1, 88.5) | 17/24 (70.8) | 20/23 (87.0) | 2.87 (0.65, 12.7) | 19/26 (73.1) | 18/21 (85.7) | 2.34 (0.24, 23.1) |
| Documentation of a recommendation by one of the patient’s clinicians to discontinue antiplatelet therapy or initiate a PPI as indicated by a clinical documentation or by a change in the EHR medication list, according to chart review | 24/47, 51.1 (26.3, 75.4) | 9/24 (37.5) | 15b/23 (65.2) | 3.16 (0.39, 25.4) | 15/26 (57.7) | 9/21b (42.9) | 0.54 (0.20, 1.42) |
| Concordance of clinicians’ recommendations for medication changes with clinical guidance summary given to cliniciansf(Note: denominator is restricted to patients who had a documented recommendation from a clinician to discontinue antiplatelet therapy or initiate a PPI according to chart review, n = 24) | 15/24, 62.5 (0.30, 0.87) | 6/9 (66.7) | 9/15 (60.0) | -b | 10/15 (66.7) | 5/9 (55.6) | -b |
| The proportion of patients who self-reported communicating about medication optimization with their clinicians based on patient recall at week 5d,e(Note: denominator is restricted to patients who completed week 5 phone assessment, n = 35) | 16/35, 45.7 (22.4,71.0) | 4/15 (26.7) | 12/20 (60.0) | -b | 10/19 (52.6) | 6/16 (37.5) | -b |
| Concordance of medication changes with clinical guidance summary given to clinicians among patients who made a changef(Note: denominator is restricted to patients who completed week 5 assessment and reported using an antiplatelet medication at baseline without a PPI and who reported making a medication change, n = 11) | 9/11, 81.8 (0.36, 0.97)b | 3/4 (75.0) | 6/7 (85.7) | -b | 5/7 (71.4) | 4/4 (100.0) | -b |
CN, clinician notification; NF, nurse facilitation; PPI, proton pump inhibitor.
Estimates of odds ratios for association between intervention group and primary and secondary outcomes were done using generalized linear mixed effects modeling, including effects for the patient-level intervention, the clinician-level intervention, and the interaction term for the 2, as well as random effects for clinician.
For excessively small sample sizes, CIs and odds ratios were not displayed because of imprecision and failure of model convergence.
CI is not estimable.
Denominator excluded patients unable to be reached or who declined to participate in the week 5 assessment.
Patients who were uncertain about whether they had communicated with their clinician about a medication change (n = 3) were categorized as “no.”
See Supplementary File S1 for clinical guidance summary provided to clinicians.