2026 Eastern States Conference

Authors 
Nakayalla Langley, PharmD, MS; Cara Goode, PharmD
 
Objective 
At the conclusion of my presentation, the participant will be able to describe clinician directed nudges and barriers to adoption of a nudge at a Veterans Affairs medical center.

Self-Assessment Question: 
Which of the following are considered nudges?

Background
To increase SGLT-2i prescribing in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure by having prescribers sign up for automated messages containing potential candidates.

Methods 
The prescriber directed nudge utilized was an already developed and available report that offers a subscription to automated instant messages and e-mails that are delivered directly to the prescriber once a week. The messages contain a link to a report that provides a list of patients scheduled in their clinic in the next week that are potential candidates for an SGLT-2 inhibitor. Subscribing to the report was not required and could only be done by the prescriber themselves. The prescribers contacted and asked to subscribe to the report included primary care providers, clinical pharmacist practitioners, and cardiology practitioners. Prescribers were communicated with through different formats, including e-mail (group and individual), instant message, in person, and video call.

Results
Between September 2025 and March 2026, nineteen prescribers were contacted about the clinical nudge alerts. Seven providers signed up for the clinical nudge alerts. Two of the seven prescribers were contacted three times before subscribing, and three of the seven were contacted two times before subscribing. Based on the feedback survey, two providers responded and indicated that the nudge system is beneficial to their practice and
integrates well into their workflow. The feedback also revealed that providers expressed the intention to either prescribe empagliflozin or make no change to their current treatment approach. In September 2025, there were 901 veterans with type 2 diabetes mellitus and atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure eligible for an SGLT2i. As of March 2026, that number has decreased to 832 veterans. 

Conclusion
This SGLT2i automated alert was associated with an increase in SGLT2i prescriptions for some prescribers but not for all. The longer a prescriber was subscribed to the SGLT2i automated alert did not seem to have an impact on whether their SGLT2i prescribing increased or decreased, however some prescribers had been subscribed to the nudge for a much longer time period than others. If a clinical nudge requires prescribers to have to opt in and sign themselves up, utilization of the nudge may not be great. Nudges that require a prescriber to voluntarily subscribe themselves via navigating a dashboard type tool may also require multiple contact attempts to the prescriber to get them to subscribe as well as direct one-on-one guidance from an individual to get them signed up.