TCTMD: A Simple Nudge Moves the Needle on Statin Prescribing

From TCTMD: Alittle nudge, in this a case a decision aid issued through the electronic health record (EHR), can help bolster statin prescriptions for eligible patients, researchers found. When combined with a reminder to patients to ask about statin therapy, these physician and patient prompts boosted statin prescribing even more among primary care physicians when compared with usual care, but simply reminding patients, via text message, didn’t have an impact on increasing statin prescribing. Srinath Adusumalli, MD, MSHP (CVS Health, Philadelphia, PA), a cardiologist who led the study when working at Penn Medicine, said the goal of a nudge is to improve patient-oriented outcomes by steering physicians toward high-value care without restricting their choices. The study showed that combining reminders, in this case to patients and clinicians, can be synergistic when it comes to altering prescribing behavior. “These types of nudges, both by using technology that is available, in this case electronic health records and automated texting, can be scalable and can serve as a template for making nudges a more-standard feature of healthcare,” he told TCTMD. A nudge, said senior investigator Mitesh Patel, MD (Ascension Health, St. Louis, MO), is a subtle change in the way information is delivered, or choices are offered, that can have a huge impact on behavior. “In the clinical setting, there are a lot of opportunities for nudges, because there are a lot of points at which patients and doctors are making decisions,” he told TCTMD. “Patients are going through the patient portal, they’re getting reminders about their visits with text messages, and they’re making decisions with verbal communication during the visits. Doctors are funneling all of their decisions through the electronic health record, so every decision they make is essentially influenced by [the information] in the drop-down [lists].” Altering the information in these drop-down lists—such as changing the settings to make statin prescribing the default setting for eligible patients—can help facilitate the best outcomes for patients and physicians, say researchers. In this case, combining nudges to patients and clinicians can deliver care for treatments that remain underutilized in clinical practice. “About half of Americans who are eligible for a statin are currently not prescribed one,” said Patel. “It’s a pretty large percentage given how remarkably effective statins are—they reduce mortality, myocardial infarction, stroke, readmissions, all by 40% or more, and they have very little side effects. . . . Given how impactful statins are, the low [rate of] side effects, it’s a big problem that only about half of people who could benefit are not taking them.” Read more at TCTMD.