Centralized Prescribing for Statins
Hyperlipidemias
About this trial
This is an interventional health services research trial for Hyperlipidemias
Eligibility Criteria
Inclusion Criteria:
- Primary Care Providers with at least 10 patients among their entire panel who meet the following criteria:
- Have a LGH PCP, AND
- 21-75 years old, AND
An indication for high- or moderate-intensity statin, AND
- Pooled cohort risk equation 10-year ASCVD risk greater than 10%, OR
- diabetes mellitus, OR
- very high LDL-C > 190 mg/dL, OR
- familial hyperlipidemia, OR
- established ASCVD,
- Not currently on statin therapy, OR on low dose-statin therapy
Exclusion Criteria:
- Have an allergy to statins
- Severe renal insufficiency defined as glomerular filtration rate (GFR) less than 30 mL/min or on dialysis
- Adverse reaction to statins including statin-related a) myopathy; b) Rhabdomyolysis; c) hepatitis
- Pregnant
- Currently breastfeeding
- On hospice or at the end-of-life
- On a PCSK9 Inhibitor medication
- Physicians (and their respective patients) will be excluded if they have less than 10 patients among their entire panel that are eligible for a statin medication.
Sites / Locations
- Lancaster General Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
No Intervention
Experimental
Experimental
Control
Non-visit Based Intervention
Visit-Based Intervention
Control arm exposed only to usual care, which consists of the passive decision support functionality Health Maintenance flag that is the current decision-support tool in the EMR.
In this arm the investigators will evaluate a non-visit-based nudge to refer patients eligible for but not prescribed high-intensity statins to centralized pharmacy services for initiation and/or titration of a statin. Practices will be randomized to usual care versus the non-visit-based nudge. The non-visit-based nudge will consist of an EPIC In-basket message sent to each provider that identifies their patients eligible for but not prescribed high- or moderate-intensity statins and notifies them that pended orders for a referral to centralized pharmacy services for statin management will be entered for these patients unless the provider opts out. At the time the in-basket message is sent out, PCPs will also have the opportunity to opt out of participating in the trial entirely.
In this arm the investigators will evaluate a visit-based nudge to refer to centralized pharmacy services to refer patients eligible for but not prescribed high-intensity statins to centralized pharmacy services for initiation and/or titration of a statin. Physicians in a single practice will be randomized to usual care versus visit-based nudge. The visit-based nudge will consist of an interruptive Best Practice Advisory (BPA) in the EMR that will trigger during non-acute patient visits and will prompt the provider to refer the patient to a centralized pharmacy service for statin initiation and management.