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Dev S, Hoffman T, Kavalieratos D, Schwenke D, Heidenreich P, Wu W, Tracy S. Barriers to Adoption and Monitoring of Mineralocorticoid Receptor Antagonists in a VA Medical Center. [Abstract]. Journal of the American College of Cardiology. 2015 Mar 1; 65(10_S):doi:10.1016/S0735-1097(15)60847-6.
Background: Poor adoption of mineralocorticoid receptor antagonist therapy (MRA) is a major gap in evidence-based care in the treatment of heart failure (HF). In order to improve care, the medical community needs a better understanding of the barriers experienced by providers. Methods: We conducted focus groups of providers (n = 42) from five populations: outpatient primary care, hospital medicine, cardiology, and pharmacy staff, and internal medicine residents. Focus groups entailed a mix of open-ended question and answer discussion, freewriting and brainstorming exercises, and polling. Focus group transcripts were analyzed with NVivo qualitative analysis software using iterative coding techniques that tagged between consideration of past research and emergent data. Results: Eight categories of barriers, centered at the provider, system, and patient levels, emerged as salient for understanding gaps in MRA prescription and monitoring (Table).