Effectiveness of a pharmacist‐led population health approach to implementing statin therapy in primary prevention patients with type 2 diabetes mellitus. Issue 4 (5th March 2020)

• Record Type: Journal Article
• Authors: Troksa, Kyle A.; Billups, Sarah J.; Claus, Liza W.; Vande Griend, Joseph P.; Saseen, Joseph J.
• Is Part Of: Journal of the American College of Clinical Pharmacy. Volume 3:Issue 4(2020)
• Page Start: 723
• Page End: 728
• Publication Date: 2020-03-05
• Subjects: healthcare -- pharmacists -- population health -- type 2 diabetes mellitus; Pharmacy -- Periodicals; Pharmacy Service, Hospital; Periodicals; Electronic journals; Periodical; 615.105
• DOI: 10.1002/jac5.1222
• Languages: English
• ISSNs: 2574-9870

Abstract

Abstract: Background: Statin therapy in patients with diabetes is an evidence‐based treatment that reduces cardiovascular risk. Percentage of primary prevention patients with diabetes that are treated with statin therapy is a common evidence‐based quality measure within value‐based health care. Pharmacist‐led services increase statin initiation rates; however, limited data have compared the effectiveness of different approaches. Study objectives: Our objective was to compare statin initiation rates of a pharmacist‐led population health initiative in University of Colorado Health System primary care practices. Design: Retrospective cohort analysis. Patients: Primary prevention patients with type 2 diabetes, age 40 to 75 years, low‐density lipoprotein cholesterol (LDL‐C) of less than 190 mg/dL, and no active statin prescriptions were identified using reports generated from the University of Colorado Health System electronic health record. Measurements and main results: Clinical pharmacists identified patients using aforementioned reports from the health record and assessed appropriateness of statin therapy according to the 2018 American Heart Association (AHA)/American College of Cardiology (ACC)/multisociety cholesterol guideline recommendations (primary prevention patients with type 2 diabetes, age 40 to 75 years, and LDL‐C of <190 mg/dL) using two different methods. The single strategy cohort utilized embedded clinical pharmacists that used an upcoming visit approach to recommend statin therapy. The dual strategy cohort utilized centrally‐located clinical pharmacists that used both an upcoming visit and a prospective patient panel approach. Seven hundred and ninety‐three patient‐specific recommendations made between March 2018 and November 2018 from both cohorts; 200 patients were randomly selected for evaluation from each cohort. Statin initiation was 46% and 36% in the single strategy and dual strategy practices, respectively ( P = .042). However across cohorts, initiation rates were 42.9% (134/312) with the upcoming visit approach and 31.5% (28/89) with the prospective patient panel approach ( P = .049). Within the total clinic population, statin prescribing among primary prevention patients with diabetes increased from 69.3% in March 2018 to 74.7% in November 2018 ( P < .05). Conclusion: This clinical pharmacist‐led initiative increased statin prescribing in primary prevention patients with type 2 diabetes who were previously untreated.