Statin Reminders for Improving Prescribing in Primary Care

Vanderbilt University Medical Center

Status: Completed

Conditions: Cholesterol, Elevated; Education; Clinical Decision Support

Treatments: Other: No Reminder; Other: Interruptive Reminder; Other: Non-interruptive Reminder

Study type: Interventional

Funder types: Other

Identifiers

NCT06456658

240419

Details and patient eligibility

About

Statins reduce cardiovascular events and mortality, but only 30% of eligible primary care patients nationally are on statins. Clinical decision support (CDS) interventions in the electronic health record (EHR) can deliver education to providers and increase adherence to guideline recommendations via many potential forms of delivery. Interruptive alerts are an effective form of CDS but disrupt clinician workflow and increase alert fatigue in an age of clinician burnout and frustration with the EHR. Non-interruptive reminders are proposed as an alternative method of delivering CDS; however, they require active pursuit by the provider, and their effectiveness compared to interruptive alerts has not been rigorously studied. The investigators propose a randomized trial comparing the effect of interruptive vs. non-interruptive reminders displayed to clinicians to increase statin prescribing in primary care clinics.

Enrollment: 3,332 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients between the ages of 18 and 75
• Seen in primary care visit within Vanderbilt University Medical Center
• Eligible for statin therapy due to 1) Atherosclerotic cardiovascular disease (ASCVD) 10- year risk greater than or equal to 10%, 2) Type 1 or 2 diabetes and aged 40 years or older, or 3) ASCVD diagnosis

Exclusion criteria

• Already on statin, ezetimibe, bempedoic acid, or PCSK9 inhibitor
• Last low-density lipoprotein cholesterol (LDL-C) less than 100 mg/dL
• Pregnant or lactating
• Palliative care
• Statin allergy or adverse effect of statin
• Rhabdomyolysis
• Statin contraindicated due to liver disease, defined as 1) Decompensated liver disease, 2) AST or ALT greater than 5 times the upper limit of normal, or 3) Total bilirubin greater than 1.5 mg/dL
• Statin contraindicated due to kidney disease, defined as 1) Dialysis or 2) Estimated glomerular filtration rate less than 15 ml/min/1.73m^2
• Has had coronary calcium computerized tomography
• Less than 3 months since lipid panel resulted
• Acute visit

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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3,332 participants in 3 patient groups

Interruptive Reminder Group

Active Comparator group

Description:

Providers will receive education via a pop-up alert at the time that the chart is opened for eligible patient visits assigned to the interruptive reminder group.

Treatment:

Other: Interruptive Reminder

Non-Interruptive Reminder Group

Active Comparator group

Description:

Providers will be able to seek out education at their own initiative via an on-demand reminder within a section of the chart for eligible patient visits assigned to the non-interruptive reminder group.

Treatment:

Other: Non-interruptive Reminder

No Reminder Group

Active Comparator group

Description:

No alert recommending a statin will be displayed/available to the provider. The system will record eligibility through triggering a "silent" reminder, which is not displayed to the clinician and exists solely for data collection purposes.

Treatment:

Other: No Reminder