VPS Improves Clinical Decisions Related to Hyperkalemia

NFK Spring Clinical Meetings 2021

Amy Larkin, PharmD, and Donald Blatherwick of Medscape Education, New York, New York, tested an intervention based on virtual patient simulation (VPS) designed to improve the performance of nephrologists related to identification of patients with, and chronic management of, hyperkalemia. Results were reported during a virtual poster session at the NFK Spring Clinical Meetings 2021 in a poster titled Success of Virtual Patient Simulation at Improving Management of Chronic Hyperkalemia.

The intervention comprised a patient presenting at two different points in time in a VPS platform allowing learners to order laboratory tests, make diagnoses, and prescribe treatments in a manner designed to match the scope and depth of actual practice. Current evidence and recommendations were used to develop tailored clinical guidance (CG) provided after each decision; the learner was then provided the opportunity to modify decisions. Following the CG, decisions were collected and compared with each user’s baseline decisions (pre-CG). P values were determined using a 2-tailed paired t-test, The activity was posted August 30, 2019; initial data were collected through November 7, 2019.

At the time of the poster presentation, 40 nephrologists who had completed the activity (completion was defined as providing all decisions within at least one case) were included in the results analysis:

Initial visit:

• Diagnosis of CKD stage 32: 3% pre-CG versus 45% post CG; 43% absolute improvement; P<.01
• Diagnosis of hyperkalemia: 50% pre-CG versus 70% post-CG; 20% absolute improvement; P<.01
• Initiation of a potassium binder: 30% pre-CG versus 73% post-CG; 43% improvement; P<.01
• Initiation of a renin-angiotensin-aldosterone (RAAS) inhibitor: 35% pre-CHG versus 73% post-CG; 38% improvement; P<.01
• Initiation of a sodium-glucose co-transporter-2 inhibitor or glucagon-like peptide-1 receptor agonist: 78% pre-CG versus 83% post-CG; 5% improvement; P=.16.

Follow-up visit:

• Initiation of a potassium binder: 28% pre-CG versus 66% post-CG; 38% Improvement; P<.01
• Initiation of a loop diuretic: 69% pre-CG versus 97% post-CG; 28% Improvement; P<.01
• Initiation of a mineralocorticoid receptor antagonist: 0% pre-CG versus 38% post-CG; 38% improvement; P<.01
• Initiation of a RAAS inhibitor: 90% pre-CG versus 93% post-CG; 3% improvement; P=.33

In conclusion, the authors said, “VPS that immerses and engages specialists in an authentic and practical learning experience can improve evidence-based clinical decisions related to patient identification and management of hyperkalemia.”

Source: Larkin, Blatherwick D. Success of virtual patient simulation at improving management of chronic hyperkalemia. Abstract of a poster presented at the National Kidney Foundation virtual Spring Clinical Meetings 2021 (Abstract #271), April 9, 2021.