Statins
Maria G. Tanzi, PharmD
Pharmacist interventions can increase the percentage of patients with atherosclerotic cardiovascular disease (ASCVD) who are on appropriate statin therapy and improve an organization’s quality metrics when conducted as part of a novel population health initiative, show new data by Haby and colleagues published in a recent issue of the Journal of the American Pharmacists Association. This initiative allowed pharmacist assessment and independent prescribing of statins in an ambulatory care setting under protocolized prescriptive authority (PPA), which did not require referral from a patient’s primary care provider.
“Expanding pharmacists’ prescriptive authority to PPA for population health initiatives is a successful strategy to increase the potential impact of pharmacy-led population health initiatives,” wrote the study authors. Pharmacists are well positioned “to continue playing an integral role in statin population health models due to their skill in understanding medication-specific differences within the statin class and providing medication and disease state education.”
Traditional model vs. new PPA model
Historically, pharmacists have increased statin use by communicating with providers and recommending the addition of statins for appropriate patients. The majority of literature reflects a reliance on engaging the patient’s provider, especially to authorize or prescribe needed statin therapy.
In contrast, the novel PPA model described in the current study allowed pharmacists to address the population independently. The study goal was to increase the proportion of patients with ASCVD on appropriate moderate- or high-dose statin therapy and to improve institutional quality metrics.
The PPA intervention took place from October 1, 2018, through December 31, 2018, within the Southwest Washington region of Providence Medical Group, in which eight primary care pharmacists were integrated into six clinics. Within Washington State, pharmacists can serve as prescribers through collaborative drug therapy agreements (CDTA) with established independent providers. For this study, individual protocol supplements to the CDTA were created to allow for the independent prescribing of statins by pharmacists (i.e., the PPA).
The intervention consisted of pharmacists screening for, directly reaching out to, and prescribing statins for patients with ASCVD who were not on appropriate therapy without the need for referral from the provider. Updates to the electronic medical record (EMR) were also made.
When statins were prescribed, pharmacists counseled patients about the statin, ordered follow-up fasting lipid panel labs, and routed EMR documentation to the patient’s provider. When patients had preexisting clinic appointments, the pharmacists coordinated with the providers to discuss statin initiation in order to capitalize on face-to-face interactions between the patient and provider.
A retrospective review of the data showed that 510 patients were screened, appropriately dosed statins were started in 40% of patients, and the EMR was accurately updated in approximately 92% of cases. This equated to an overall success rate of 50.5%. In terms of quality metrics, the percentage of patients prescribed an appropriate statin therapy rose from 75.2% before the PPA intervention to 79.3% at the end of the intervention, surpassing the medical group’s goal of 78.3%.
Practice pearls
ASCVD remains the leading cause of mortality and morbidity in the United States, and appropriate use of statins in this patient population has been shown to improve outcomes. The current analysis supports a pharmacist-led, population-based intervention to improve statin use, but select factors need to be considered for these programs to be successful.
Providers need to buy into the idea, and pharmacists must be well educated on current lipid guidelines as well as statin efficacy and safety data. Patients need to clearly understand the risk–benefit profile of statins so they can make an informed decision whether to initiate therapy.
Patients with ASCVD identified through these types of programs should also be educated on key lifestyle interventions aimed at reducing cardiovascular disease morbidity and mortality, such as not smoking, the importance of maintaining a healthy weight and engaging in adequate physical activity, as well as eating a balanced heart-healthy diet.
Other cardiovascular risk factors should also be addressed (if possible), such as reaching appropriate blood pressure goals and glucose levels in patients with hypertension and diabetes, respectively.