Self-identified prescriber tendencies in sodium-glucose cotransporter-2 inhibitor outpatient prescribing

Background Despite expanded indications and demonstrated cardiovascular and renal benefits, prescribing rates of SGLT-2 inhibitors are low. Objectives The study aimed to identify factors impacting prescriber decision-making when prescribing SGLT-2 inhibitors in the outpatient setting and identify differences across specialties in self-identified prescribing patterns. Methods An anonymous survey was administered electronically to prescribers in relevant specialties at a large community health system. Descriptive statistics were used to compile results and subgroup comparisons were conducted utilizing Fisher's exact test. Results Fifty-one prescribers completed the survey, representing a 25.2% response rate. The highest reported prescribing rates were for type 2 diabetes (92%), and the lowest for HFpEF (20%) and ASCVD risk reduction (16%). Prescribers without clinic-embedded pharmacist were more likely to report cost and insurance had at least a moderate effect on prescribing compared to prescribers with clinic-embedded pharmacists (95.3% vs. 62.5%, p=0.0228) and less likely to report hemoglobin A1c less than 6.5% to have at least a moderate effect on prescribing (20.9% vs. 62.5%, p=0.0317). Compared to specialty providers, primary care prescribers were more likely to report hemoglobin A1c over 9% had at least a moderate effect on prescribing (92.0% vs. 42.9%, p=0.0082) and less likely to note history of urinary tract infection (22.2% vs. 85.7%, p=0.0028), history of mycotic infection (38.9% vs. 100%, p=0.0036), and sex (male: 5.6% vs. 42.9%, p = 0.0242; female: 8.0% vs. 42.9%, p=0.0447) had at least a moderate effect on prescribing. Conclusion Prescribing hesitancies vary across specialty and when clinic-embedded pharmacists are present. Pharmacists may help improve SGLT-2 inhibitor prescribing rates and use of guideline-directed therapies. Pharmacists can target identified hesitancies through medication access consultations, education regarding adverse effects, and expanded benefits of the class. Future studies should examine the impact of pharmacist intervention on SGLT-2 inhibitor prescribing rates.