Improving statin prescription through the involvement of nurses in the provision of ASCVD score: a quality improvement initiative in primary care

ABSTRACT

Objectives

This study compares two methods of providing CVD risk score on the percentage of appropriate statin therapy for primary prevention of CVD in family medicine clinics, according to the American Heart Association guidelines.

Methods

Participants were non-diabetic patients aged 40 to 75 with a recently ordered low-density lipoprotein (LDL) level, not on statin therapy and free of CVD. The first intervention is passive with a display of the score on the EMR in the vital signs section and lasted for three months. The second intervention is collaborative where the nurses calculate the risk score and displayed it to the physician along with therapy recommendations. Electronic health records were reviewed to randomly select medical charts of eligible patients.

Results

162 charts were randomly selected out of 547 eligible charts and included in the analysis, including 60 charts for the baseline group. Among moderate-risk patients, the percentage of appropriate statin initiation was 0% at baseline and after intervention 1; yet it increased to (33.3% [7.5–70.1, 95% CI]) after intervention 2. Among high risk patients, percentage of appropriate statin initiation was 9.1% [0.1–41.3, 95% CI], 11.1% [1.4, 34.7, 95% CI] and 28.6% [8.4, 58.1, 95% CI] during baseline, intervention 1 and intervention 2, respectively.

Conclusion

The provision of the CVD risk score alone as clinical decision support is not enough to improve statin initiation for primary prevention. The nurse collaboration can improve guideline-concordant statin initiation.

KEYWORDS:

• Primary care
• statin
• electronic health record
• clinical decision support
• prescribing
• lipidemia

Declaration of interest

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Reviewer’s disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.