Evaluation of a Pharmacist-Led Intervention to Improve Statin Use in Persons with Diabetes

Abstract

BACKGROUND: The Statin Use in Persons with Diabetes (SUPD) measure, developed and endorsed by the Pharmacy Quality Alliance and National Quality Forum, has been adopted by the Centers for Medicare & Medicaid Services as part of the star rating measure set. It was added as a display measure in 2015 and, as of 2019, has become a star measure. Clinical pharmacy specialists (CPS) embedded in the patient-centered medical home (PCMH) are well positioned to review and recommend statin therapy for patients with diabetes in order to improve patient care and health plan performance.OBJECTIVE: To improve rates of statin prescribing and performance on the SUPD measure in the Denver Health Medical Plan (DHMP) population with diabetes by creating a CPS-led intervention to initiate statin prescriptions in eligible patients.

Pharmacist-Led Programs to Increase Statin Prescribing: A Narrative Review of the Literature

“…A prospective trial by Anderson et al [ 19 ] assessed the effectiveness of clinical pharmacists embedded within several patient centered medical home (PCMH) clinics to improve the statin use in persons with DM (SUPD) measure among a managed care population. A list of patients was received aged 40–75 with at least two medication fills for DM with no statin prescription.…”

“…Two trials evaluated two different types of pharmacy interventions, direct-patient outreach versus coordinating with providers about statin eligibility prior to an upcoming patient appointment [ 17 , 18 ] each reporting a statistically greater proportion of patients prescribed statin therapy with the provider coordination intervention vs. the direct-patient outreach intervention. However, Anderson et al [ 19 ] reported somewhat similar success with a direct-patient outreach intervention which allowed pharmacists to prescribe statins in consenting patients via a CDTM protocol. In each of these studies, pharmacists were to some degree already implemented in these clinical sites, suggesting a positive provider-pharmacist relationship may have already been formed.…”

Retrospective cohort study of statin prescribing for primary prevention among people living with HIV

“…System-wide prospective interventions by clinical pharmacists have been shown to increase guideline-directed statin therapy for indications such as diabetes and ASCVD. 25 – 29 These approaches are Class I recommendations in the 2018 AHA/ACC/Multisociety cholesterol guideline for implementation of evidence-based statin therapy. 7 A similar combination of approaches including chart review, reporting systems, and prospective recommendations and/or direct prescribing by a clinical pharmacist or health promotion team has the potential to be utilized in the PLWH population.…”

Impact of a clinical pharmacist in an outpatient heart transplant clinic

“…Current guidelines recommend that all patients be started on a statin 1 to 2 weeks following heart transplant regardless of cholesterol levels , making statin therapy a cornerstone of CAV prevention 1 . Despite their known benefits, statin intolerance in HTRs is commonly reported, 7 often leading to discontinuation of therapy. Similar to the nontransplant literature in hypertension management, pharmacist integration has demonstrated improved statin utilization among nontransplant recipients, 7 and pharmacists are well‐poised to educate, personalize, and re‐challenge therapy as appropriate to improve statin compliance.…”

“…Despite their known benefits, statin intolerance in HTRs is commonly reported, 7 often leading to discontinuation of therapy. Similar to the nontransplant literature in hypertension management, pharmacist integration has demonstrated improved statin utilization among nontransplant recipients, 7 and pharmacists are well‐poised to educate, personalize, and re‐challenge therapy as appropriate to improve statin compliance.…”