Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system

Ahmed, Sarah T.; Mahtta, Dhruv; Rehman, Hasan; Akeroyd, Julia M.; Rifai, Mahmoud Al; Rodríguez, Fátima; Jneid, Hani; Nasir, Khurram; Samad, Zainab; Alam, Mahboob; Petersen, Laura A.; Virani, Salim S.

doi:10.1016/j.ahj.2019.11.019

Cited by 13 publications

(11 citation statements)

References 28 publications

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“…Even so, our findings are aligned with extant evidence that shows reduced preventive care in persons with diabetes by high-volume primary care providers, [6,15,16] as well as a correlation between visit frequency, continuity of care and likelihood of receiving preventive testing and medicines in persons with diabetes [37,42] and heart disease. [43,44] Similar to our findings, Cadieux et al showed that high-volume PCPs were more likely than low-volume PCPs to inappropriately prescribe non-indicated antibiotics, [13] and Kroll et al showed that frequent visitors in primary care were more likely to receive benzodiazepine prescriptions [45]. Although some high-volume PCPs work longer hours to see more patients per day, at least some of their high volume comes at the cost of visit-time per patient [10].…”

Section: Discussionsupporting

confidence: 86%

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

et al. 2021

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Background Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.

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Section: Discussionsupporting

confidence: 86%

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

et al. 2021

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“…While clinic visit time often is an impediment to uptake of many practices in primary care and difficult to change [ 36 , 37 ], having one additional visit with the PCP annually (e.g. 2 visits vs 3 visits) was associated with higher odds of evidence-based statin use among general primary care patients, suggesting that having the additional visit allowed the patient to discuss statin therapy with the PCP and lead to more statin prescriptions [ 38 ]. Other facilitators could include standard operating procedures, EMR tools, and performance measures and feedback around CVD risk assessment and statins [ 39 – 41 ].…”

Section: Discussionmentioning

confidence: 99%

Factors affecting statin uptake among people living with HIV: primary care provider perspectives

et al. 2021

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Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. Methods We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. Results Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. Conclusions Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake.

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“…Prior studies of patients with ASCVD in the Veterans Affairs system found similar results, showing a dose response relationship with patients having a higher statin use and statin adherence if they had more visits by either cardiology or primary care 9,18 . Other studies have noted routine, guideline‐directed completion of lipid panels is associated with a modest increase in statin adherence 15 .…”

Section: Discussionmentioning

confidence: 72%

Cardiology clinic visit increases likelihood of evidence‐based cholesterol prescribing in severe hypercholesterolemia

Groth

Stone

Benziger

2020

Clinical Cardiology

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Background Patients with phenotypic severe hypercholesterolemia (SH), low‐density lipoprotein‐cholesterol (LDL‐c) ≥ 190 mg/dl, atherosclerotic cardiovascular disease (ASCVD) or adults 40–75 years with diabetes with risk factors or 10‐year ASCVD risk ≥20% benefit from maximally tolerated statin therapy. Rural patients have decreased access to specialty care, potentially limiting appropriate treatment. Hypothesis Prior visit with cardiology will improve treatment of severe hypercholesterolemia. Methods We used an electronic medical record‐based SH registry defined as ever having an LDL‐c ≥ 190 mg/dl since January 1, 2000 (n = 18 072). We excluded 3205 (17.7%) patients not alive or age 20–75 years. Patients defined as not seen by cardiology if they had no visit within the past 3 years (2017–2019). Results We included 14 867 patients (82.3%; mean age 59.7 ± 10.3 years; 58.7% female). Most patients were not seen by cardiology (n = 13 072; 72.3%). After adjusting for age, sex, CVD, hypertension, diabetes and obesity, patients seen by cardiology were more likely to have any lipid‐lowering medication (OR = 1.46, 95% CI: 1.29–1.65), high‐intensity statin (OR = 1.81, 95% CI: 1.61–2.03), or proprotein convertase subtilisin‐kexin type 9 (PCSK9) inhibitor (OR = 5.96, 95% CI: 3.34–10.65) compared to those not seen by cardiology. Mean recent LDL‐c was lower in patients seen by cardiology (126.8 ± 51.6 mg/dl vs. 152.4 ± 50.2 mg/dl, respectively; p < .001). Conclusion In our predominantly rural population, a visit with cardiology improved the likelihood to be prescribed any statin, a high‐intensity statin, or PCSK9 inhibitor. This more appropriately addressed their high life‐time risk of ASCVD. Access to specialty care could improve SH patient's outcomes.

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Association between frequency of primary care provider visits and evidence-based statin prescribing and statin adherence: Findings from the Veterans Affairs system

Cited by 13 publications

References 28 publications

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

Factors affecting statin uptake among people living with HIV: primary care provider perspectives

Cardiology clinic visit increases likelihood of evidence‐based cholesterol prescribing in severe hypercholesterolemia

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