
PMID- 42522049
OWN - NLM
STAT- MEDLINE
DCOM- 20260729
LR  - 20260729
IS  - 2574-9870 (Electronic)
IS  - 2574-9870 (Linking)
VI  - 9
IP  - 8
DP  - 2026 Aug
TI  - Contextual Factors Affecting SGLT2 Inhibitors and GLP-1 Receptor Agonists 
      Prescribing in Primary Care: An Application of the Consolidated Framework for 
      Implementation Research.
PG  - e70263
LID - 10.1002/jac5.70263 [doi]
AB  - BACKGROUND: Despite strong evidence supporting cardiovascular and kidney benefits 
      of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like 
      peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes, 
      prescribing rates remain suboptimal. The aim of this study was to assess 
      clinicians' knowledge and comfort prescribing SGLT2i and GLP-1 RA in clinical 
      practice and factors influencing prescribing of these agents. METHODS: This 
      multi-methods study used questionnaires to assess self-reported knowledge and 
      comfort prescribing SGLT2i and GLP-1 RA, and semi-structured interviews based on 
      the Consolidated Framework for Implementation Research (CFIR) to assess factors 
      affecting prescribing decisions among 21 clinicians (12 primary care physicians, 
      4 pharmacists, 5 nurse practitioners) at a large community-based health system in 
      Virginia. Questionnaire results were analyzed using descriptive statistics, and 
      interviews used a two-phase analytic approach combining inductive and deductive 
      coding. RESULTS: Clinicians self-reported high knowledge (7.9/10) and comfort 
      (8.1 and 8.4/10) prescribing SGLT2i and GLP-1 RA but identified multiple 
      implementation barriers. The most significant barriers were insurance coverage 
      and out-of-pocket costs, with prior authorization requirements delaying therapy 
      initiation. Medicare beneficiaries faced particularly challenging access due to 
      coverage gaps and ineligibility for manufacturer assistance programs. 
      Organizational factors, including high workload, limited appointment time, and 
      the absence of automated patient identification systems, hindered consistent 
      prescribing. Medication burden, side effects, and aversion to injectable 
      medications emerged as patient-related barriers. Facilitators included strong 
      clinical evidence supporting these agents, organizational culture supportive of 
      innovation, and access to pharmacist support. CONCLUSION: Despite high 
      self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, clinicians 
      identified barriers to their use in clinical practice at the patient, clinician, 
      organizational, and medication access levels. Future work should identify the 
      best implementation strategies to address these barriers.
CI  - (c) 2026 The Author(s). JACCP: Journal of the American College of Clinical Pharmacy 
      published by Wiley Periodicals LLC on behalf of ACCP Foundation, Ltd.
FAU - Salgado, Teresa M
AU  - Salgado TM
AUID- ORCID: 0000-0003-2708-7145
AD  - Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth 
      University School of Pharmacy, Richmond, Virginia, USA.
AD  - Center for Pharmacy Practice Innovation, Virginia Commonwealth University School 
      of Pharmacy, Richmond, Virginia, USA.
FAU - Amayreh, Rana
AU  - Amayreh R
AUID- ORCID: 0009-0009-7136-6273
AD  - Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth 
      University School of Pharmacy, Richmond, Virginia, USA.
FAU - Alshahawey, Mona
AU  - Alshahawey M
AUID- ORCID: 0000-0001-7424-2799
AD  - Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth 
      University School of Pharmacy, Richmond, Virginia, USA.
AD  - Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, 
      Cairo, Egypt.
FAU - Musselman, Kerri T
AU  - Musselman KT
AD  - CKB Health Consulting LLC, Midlothian, Virginia, USA.
FAU - Buffington, Tonya M
AU  - Buffington TM
AD  - Bon Secours Mercy Health, Richmond, Virginia, USA.
FAU - Hyder, Haroon
AU  - Hyder H
AD  - Bon Secours Mercy Health, Richmond, Virginia, USA.
FAU - Jones, Resa M
AU  - Jones RM
AUID- ORCID: 0000-0002-0080-4047
AD  - Department of Epidemiology and Biostatistics, Barnett College of Public Health, 
      Temple University, Philadelphia, Pennsylvania, USA.
AD  - Fox Chase Cancer Center, Temple Health, Temple University, Philadelphia, 
      Pennsylvania, USA.
FAU - Dixon, Dave L
AU  - Dixon DL
AUID- ORCID: 0000-0001-7560-9521
AD  - Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth 
      University School of Pharmacy, Richmond, Virginia, USA.
AD  - Center for Pharmacy Practice Innovation, Virginia Commonwealth University School 
      of Pharmacy, Richmond, Virginia, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Clin Pharm
JT  - Journal of the American College of Clinical Pharmacy : JACCP
JID - 101723133
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Glucagon-Like Peptide-1 Receptor Agonists)
RN  - 0 (Hypoglycemic Agents)
SB  - IM
MH  - Humans
MH  - *Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
MH  - *Glucagon-Like Peptide-1 Receptor Agonists
MH  - *Diabetes Mellitus, Type 2/drug therapy
MH  - *Primary Health Care
MH  - *Practice Patterns, Physicians'/statistics & numerical data
MH  - Surveys and Questionnaires
MH  - Male
MH  - Female
MH  - *Hypoglycemic Agents/therapeutic use
MH  - Pharmacists
MH  - Health Knowledge, Attitudes, Practice
MH  - Implementation Science
OTO - NOTNLM
OT  - diabetes mellitus
OT  - evidence-based practice
OT  - glucagon-like peptide-1 receptor agonists
OT  - implementation science
OT  - primary health care
OT  - qualitative research
OT  - sodium-glucose transporter 2 inhibitors
EDAT- 2026/07/29 00:35
MHDA- 2026/07/29 18:39
CRDT- 2026/07/28 23:52
PHST- 2026/06/17 00:00 [revised]
PHST- 2026/04/29 00:00 [received]
PHST- 2026/07/02 00:00 [accepted]
PHST- 2026/07/29 18:39 [medline]
PHST- 2026/07/29 00:35 [pubmed]
PHST- 2026/07/28 23:52 [entrez]
AID - 10.1002/jac5.70263 [doi]
PST - ppublish
SO  - J Am Coll Clin Pharm. 2026 Aug;9(8):e70263. doi: 10.1002/jac5.70263.
