Appropriate Statin Prescribing Soars with Automated Referrals to Pharmacy Services
Issue
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality in the United States and worldwide. A few factors contribute to the problem of ASCVD risk: poor uptake and adherence to medications, persistently unhealthy behaviors, and a system incentivized to treat rather than prevent.
The Big Takeaway
In a pilot study, members of CHIBE helped discover that using automated referrals to pharmacy services can boost appropriate statin prescribing. Now, Penn Medicine will fund scaled implementation of this intervention, allowing this research to be translated into practice.
The Study
A pilot study conducted by the Penn Medicine Healthy Heart program found that using automatic referrals to pharmacy services for statins can drastically increase statin prescription rates for patients who would benefit from them. Researchers found that the odds of prescribing the appropriate dose of statins increased sixfold when automated referrals were made to pharmacy services, instead of relying on doctors to assess a patient’s cardiovascular risk and determine whether a statin is needed and at what dose – a process that physicians may not have adequate time for during a patient’s visit.
In a cluster randomized trial, eligible patients in the intervention arm were automatically referred to a centralized pharmacy service, where pharmacists contacted the patients, discussed the use of statins, and initiated therapy when appropriate. There were 1,950 patients in the trial and 975 were assigned to the intervention arm.
The Results
The researchers discovered that around 86% of the eligible patients were not prescribed statins at baseline, and others were receiving a dose that was too low. In the intervention arm, there was a significant boost in statin prescription rates – 31.6% were prescribed a statin compared with around 15% in the usual care group. The researchers also found that nearly 25% of the patients in the intervention arm were prescribed a statin at the guideline-recommended dose during the study period compared with 7.7% of patients in the usual care group.
“This is a really great example of how research is being directly translated to practice, so we are able to scale evidenced-based care across Penn Medicine in a rapid manner. This collaboration between CHIBE and the Center for Health Care Transformation and Innovation (CHTI) not only improves efficiency but also ensures that more patients receive the necessary medications to reduce their risk of cardiovascular events. This project embodies our goals for a learning health system and transformation at Penn Medicine,” said Raina Merchant, MD, MSHP, FAHA, Executive Director of CHTI and member of CHIBE’s Internal Advisory Board.
Learn More
With support from the NIH Clinical and Translational Science Award and institutional support from Penn Medicine, Penn Medicine Healthy Heart is a 6-month program for the reduction of hypertension and hypercholesterolemia grounded in behavioral economics insights to increase uptake of and adherence to evidence-based interventions to reduce ASCVD risk. This text-based program offered to approximately 2,000 Penn Medicine primary care patients in West and Southwest Philadelphia and Lancaster County in 2024 as part of a clinical trial to evaluate its effectiveness. The goal is to help patients take action to reduce their heart disease risk by lowering their blood pressure and cholesterol from home while providing additional resources to busy primary care providers.
Study Authors
Alexander Fanaroff, MD, MHS; Qian Huang, MPH; Kayla Clark, MPH; Laurie Norton, MBE; Wendell Kellum, MD; Dwight Eichelberger, MD; John Wood, MD; Zachary Bricker, MSN, RN; Andrea Dooley Wood, PharmD; Greta Kemmer, PharmD; Jennifer Smith, PharmD; Srinath Adusumalli, MD; MSHP, MBMI; Mary Putt, PhD, ScD; and Kevin Volpp, MD, PhD