Topic

Chlorthalidone Versus Hydrochlorothiazide: A New Kind of VA Cooperative Study

Presenter

Frank A. Lederle, MD, Professor of Medicine, University of Minnesota’s Center for Chronic Disease Outcomes Research, and Minneapolis VA Health Care System

Keywords

Pragmatic clinical trial; Comparative effectiveness research; Diuretics; HCTZ; Point-of-care; EHRs; Diuretic Comparison Project; DCP; VA; Veterans

Key Points

• The VA’s Point-of-Care Program was developed to optimize the use of EHRs to perform large, inexpensive clinical trials that are integrated at the point of care. Such trials involve finding eligible patients using the VA’s EHR system, with centralized recruitment, enrollment, and placement of notes and orders in the EHR. Collection of outcomes is also centralized, and no local personnel are needed.
• The key question for the VA’s Diuretic Comparison Project arose from existing clinical equipoise around two common diuretics used to treat hypertension in older Veterans. This study asks: Does treatment with chlorthalidone reduce major adverse cardiovascular events when compared with hydrochlorothiazide in older Veterans with hypertension?
• In this study, primary care physicians (PCPs) are consented to participate as study subjects in order to evaluate how effectively they implement the protocol. The PCP manages the patient’s dose, monitoring, and data collection as usual; no extra clinic time is involved.

Discussion Themes

With pragmatic trials, often the eligible population is large but engagement is low, especially when enrollment is centralized. How are you dealing with such issues?

The Diuretic Comparison Project is considered a large, inexpensive trial, with the cost per patient less than $750 when the estimated 13,500 patient enrollment is achieved.

For More Information

For details, visit the VA’s Diuretic Comparison Project homepage.

Tags
#DiureticComparisonProject, #PCORnet, #pctGR
@DeptVetAffairs, @PCTGrandRounds, @Collaboratory1, @PCORnetwork