This article is more than 5 years old. Information may no longer be current.
PRESCRIBE: Automated patient dashboard boosts appropriate statin prescriptions
An automated patient dashboard was associated with a “modest but significant” increase in statin prescriptions concordant with guidelines, researchers reported in JAMA Network Open.
The researchers conducted a three-arm cluster randomized trial (PRESCRIBE) at 32 U.S. sites consisting of 96 primary care physicians and 4,774 patients not previously prescribed statins.
One group was assigned the automated patient dashboard with active choice framing and peer comparison, another was assigned the automated patient dashboard with active choice framing but without peer comparison and the third was assigned to the usual care.
According to the researchers, in the usual-care arm, the providers and patients received no communications or interventions; in both intervention arms, the provider received an email indicating which patients were indicated for statins by guidelines but had not been prescribed them and a link to a dashboard with each patient’s relevant information; and in the peer-comparison arm, the email also included the provider’s prior statin prescribing rates in comparison with their peers.
For each patient appearing in the dashboard, the provider was asked to select one of the following options: prescribe atorvastatin 20 mg per day, prescribe atorvastatin at a different dose, prescribe a different statin or do not prescribe a statin.
The primary outcome was change in percentage of eligible patients prescribed a statin over 2 months.
Differences in prescriptions
Among the patients, the mean age was 62 years, the mean 10-year atherosclerotic CVD risk score was 13.6%, 55% were men and 28% were black.
In the active choice without peer comparison arm, 50% of providers accessed the patient dashboard and 6.3% prescribed statins, whereas in the active choice with peer comparison arm, 37.5% of providers accessed the patient dashboard and 25% prescribed statins, Mitesh S. Patel, MD, MBA, MS, from the Penn Medicine Nudge Unit and the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote.
Among patients, 2.6% of those in the usual-care arm, 6.7% of those in the active choice without peer comparison arm and 8% of those in the active choice with peer comparison arm received statin prescriptions, according to the researchers.
After adjustment, compared with the usual-care arm, the active choice with peer comparison arm had a significant increase in statin prescriptions (adjusted difference in percentage points, 5.8; 95% CI, 0.9-13.5) but the active choice without peer comparison arm did not (adjusted difference in percentage points, 4.1; 95% CI, –0.8 to 13.1).
“These interventions would likely fit better within physician workflow if deployed through the EHR rather than alongside it,” Patel and colleagues wrote.
Attractive approach
“Patel and colleagues cogently argue that their approach is attractive because it is simple, short and minimally intrusive on harried primary care providers,” Stephan D. Fihn, MD, MPH, from the department of medicine at the University of Washington, wrote in a related editorial. “On the other hand, if this technique was used simultaneously to address numerous quality issues, it might come to be perceived as onerous in the same way that clinicians currently view clinical reminders in the electronic health record.” – by Erik Swain
Disclosures: Patel reports he received personal fees from Catalyst Health LLC, Healthmine Services Inc. and Life.io. Please see the study for all other authors’ relevant financial disclosures. Fihn reports no relevant financial disclosures.