centralized prescribing for statins

Conditions: Hyperlipidemias

Summary: this pilot study consists of a pair of pragmatic clinical trials that will evaluate two separate methods for optimizing referral of eligible patients to a centralized pharmacy service for statin management: 1) a stepped wedge clinical trial, with randomization at the level of the provider, evaluating a visit-based nudge for referral to pharmacy services versus usual care; 2) a cluster randomized trial, with randomization at the level of the practice, evaluating a non-visit based nudge for referral to pharmacy services versus usual care.

this pilot study consists of a pair of pragmatic clinical trials that will evaluate two separate methods for optimizing referral of eligible patients to a centralized pharmacy service for statin management: 1) a stepped wedge clinical trial, with randomization at the level of the provider, evaluating a visit-based nudge for referral to pharmacy services versus usual care; 2) a cluster randomized trial, with randomization at the level of the practice, evaluating a non-visit based nudge for referral to pharmacy services versus usual care. for trial #1, the investigators will identify pcps at a single practice with at least 10 patients on their panel who are eligible for but not yet prescribed high- or moderate-intensity statin medication. these physicians will be randomized in stepped-wedge fashion to usual care or to a nudge, delivered at the time of a scheduled office visit, to refer appropriate patients to centralized pharmacy services for initiation and/or titration of a statin medication. in trial #2, the investigators will identify pcps at 12 practices with at least 10 patients on their panel who are eligible for but not yet prescribed high- or moderate-intensity statin medication. practices will be randomized to usual care or to a non-visit-based nudge to refer appropriate patients to centralized pharmacy services for initiation and/or titration of a statin medication. it is estimated that 13 practices and 83 providers will be eligible to participate in the two trials. the invesitgators will run the intervention over a 9-month time frame. the primary outcome is the prescription of a statin for eligible patients during the 9-month timeframe. secondary outcomes will include the prescription of guideline-directed intensity of statin medications as well as statin pharmacy dispense rate. the investigators will also assess ldl control over the study period.

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.