Patient Care: Statin Prescribing in Primary Care Boosted with EHR Prompts Plus Patient Alerts

From Patient Care: The use of electronic health record (EHR)-embedded prompts, or nudges, significantly increased statin prescribing by 5.5% among 28 primary care practices compared with usual care, according to new data from Penn Medicine’s Nudge Unit. The data also showed that a previsit nudge to patients via text message without a subsequent ERH nudge to the physician did not impact statin prescribing. However, the combination of nudges to clinicians and patients significantly increased statin prescribing by 7.2%. The findings are encouraging, study authors write, because while statins are widely known to reduce cardiovascular-related morbidity and mortality, nearly 50% of patients who meet evidence-based guidelines for the medications have never been prescribed one. “To our knowledge, this study is one of the largest clinical trials testing nudges to clinicians and patients. Because these interventions were automated through the EHR, they provide a scalable template that can be used by health systems more broadly to improve patient care,” wrote investigators led by Srinath Adusumalli, MD, MSHP, MBMI, the deputy director at the Penn Medicine Nudge Unit. The Nudge Unit at Penn Medicine is described as the world’s first behavioral design team embedded within a health system. The Unit’s mission is to use insights from behavioral and implementation science to develop and deploy “scalable nudges to steer medical decision making” toward optimal patient outcomes. The current cluster randomized clinical trial evaluated statin prescribing among 158 clinicians from 28 primary care practices in urban and suburban Pennsylvania and New Jersey. The trial began with a 12-month preintervention period during which investigators identified clinicians who treated <10 patients eligible for a new statin prescription and was followed by a 6-month intervention period. Participants were randomized in a 1:1:1:1 fashion to a usual care group (no interventions); a clinician nudge group (EHR active choice prompt during patient visit and monthly peer feedback on prescribing patterns); a patient nudge group (interactive text message deployed 4 days prior to visit); and a combined nudge group. The final cohort of 4131 participants had a mean age of 65.5 years; 51.3% were men, 29.3% were Black, 2.6% were Hispanic, and 66.1% were White. Atherosclerotic cardiovascular disease was diagnosed at baseline in 22.6% (n=933) of the group. Read more at Patient Care.