Daily Dose: Statin Prescribing in Primary Care

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On December 5, 2022, we reported on a study published in JAMA Cardiology that evaluated whether nudges to clinicians, patients, or both increase initiation of statin prescribing during primary care visits.

The study

A cluster randomized clinical trial examined statin prescribing of 158 clinicians from 28 primary care practices including 4131 patients. The design included a 12-month preintervention period and a 6-month intervention period between October 19, 2019, and April 18, 2021. 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 results

Analysis of 12-week preintervention prescribing found that statins were prescribed to 5.6% of patients in the usual care, 4.8% in the patient nudge, 6.0% in the clinician nudge, and 4.7% in the combined nudge groups.

During the 6-week intervention period Adusumalli et al report statins were prescribed in the 4 treatment groups as follows:

• Usual care 7.3%

• Patient nudge 8.5%

• Clinician nudge 13.0%

• Combined nudge 15.5%

In the main adjusted analyses relative to usual care, clinician nudges were associated with significantly increased statin prescribing alone and when combined with the patient nudge. In contrast, patient nudges alone did not significantly increase statin prescribing relative to usual care.

Clinical implications

"These findings demonstrate the potential benefit and scalability of using nudges to change prescribing behavior through automated processes within the EHR."

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