Centralized Statin Prescribing Strategies for High Cholesterol

KC
Overseen ByKayla Clark, MPH
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: University of Pennsylvania
Must be taking: Statins
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two methods to help doctors refer patients to a special pharmacy service for managing high cholesterol with statins (cholesterol-lowering drugs). One method provides a reminder during a doctor's visit, while the other sends a message to doctors outside of visits. Suitable candidates have high cholesterol concerns, are not currently on high-intensity statins, and have either diabetes, a history of heart disease, or very high LDL (bad cholesterol) levels. Participants in this trial will help researchers identify the best approach to ensure more people receive effective cholesterol-lowering treatment. As an unphased trial, this study offers a unique opportunity to contribute to improving healthcare practices for managing high cholesterol.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it does require that participants are either not on statin therapy or only on a low-dose statin. If you are on a PCSK9 Inhibitor, you cannot participate.

What prior data suggests that these methods for statin management are safe?

Research has shown that statin medications are generally safe and effective for most people. They lower cholesterol and reduce the risk of heart disease. However, some individuals might experience side effects such as muscle pain, digestive issues, or changes in liver function. These side effects are usually mild and affect only a small number of people.

The clinical trials aim to improve how doctors recommend statins to patients. Both methods focus on encouraging the use of statins in patients at high risk for heart problems. Previous studies on similar methods have not identified any major safety issues.

These methods guide doctors in prescribing statins but do not alter the safety of the statins themselves. Instead, they ensure that patients who need statins receive them. Overall, for those considering joining a trial involving statins, current evidence suggests that the medication is safe for most people.12345

Why are researchers excited about this trial?

Researchers are excited about these new strategies for managing high cholesterol because they offer a fresh approach to prescribing statins, which are the standard treatment for this condition. Unlike traditional methods that rely on in-person visits, the non-visit-based intervention uses digital nudges, like EPIC In-basket messages, to streamline patient referrals to centralized pharmacy services. This can potentially make statin management more efficient and accessible. Meanwhile, the visit-based intervention introduces an interruptive Best Practice Advisory during non-acute visits, prompting timely referrals for statin initiation. These innovative approaches aim to enhance adherence to statin therapy and optimize cholesterol management without the need for frequent office visits, which could lead to better health outcomes for patients.

What evidence suggests that this trial's interventions could be effective for managing high cholesterol?

Research shows that gentle reminders, or "nudges," can increase the use of statins, medicines that lower cholesterol. This trial will include participants in different arms to evaluate these strategies. The Visit-Based Intervention arm will test reminders given to doctors during regular check-ups; studies have found that these reminders increase the number of patients starting statins. The Non-visit Based Intervention arm will assess the impact of reminders sent to doctors outside of visits, such as messages, which have also increased statin prescriptions. These strategies help doctors remember to prescribe statins, which reduce heart problems. By making it easier for doctors to guide patients to pharmacy services, these nudges could improve cholesterol management and lower the risk of heart disease.16789

Who Is on the Research Team?

AF

Alexander Fanaroff, MD, MHS

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for primary care providers with patients aged 21-75 who need high or moderate-intensity statin therapy but aren't currently on it, or are on a low dose. Patients should have a risk of heart disease over the next ten years greater than 10%, diabetes, very high LDL cholesterol, familial hyperlipidemia, or established heart disease.

Inclusion Criteria

I am a PCP with at least 10 patients needing high or moderate-intensity statin therapy.

Exclusion Criteria

You are allergic to statin medications.
I am currently taking a PCSK9 inhibitor medication.
Currently breastfeeding
See 5 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants are randomized to either a visit-based or non-visit-based nudge to refer eligible patients to centralized pharmacy services for statin management

9 months
Varies based on intervention type

Follow-up

Participants are monitored for statin prescription rates and LDL control

9 months

What Are the Treatments Tested in This Trial?

Interventions

  • Non-visit Based Intervention
  • Visit-Based Intervention
Trial Overview The study tests two methods to encourage referrals to pharmacy services for managing statins: one during patient visits and another outside of visits. Providers are randomly chosen to suggest these services differently in their practices.
How Is the Trial Designed?
3Treatment groups
Experimental Treatment
Active Control
Group I: Visit-Based InterventionExperimental Treatment1 Intervention
Group II: Non-visit Based InterventionExperimental Treatment1 Intervention
Group III: ControlActive Control1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials
2,118
Recruited
45,270,000+

Published Research Related to This Trial

Although statin-associated adverse effects are rare, their increasing use has led to a notable number of patients experiencing these issues, necessitating referrals to specialists.
This report offers a consensus approach for effectively managing statin-related side effects, aiming to optimize treatment for patients needing cardiovascular risk reduction while minimizing unnecessary testing and referrals.
Diagnosis, prevention, and management of statin adverse effects and intolerance: proceedings of a Canadian Working Group Consensus Conference.Mancini, GB., Baker, S., Bergeron, J., et al.[2012]

Citations

Effect of Nudges to Clinicians, Patients, or Both to Increase ...Nudges to clinicians with and without a patient nudge significantly increased initiation of a statin prescription during primary care visits.
Interventions to improve adherence to lipid-lowering drugsOur findings show that while interventions were generally effective in improving medication adherence, both as continuous (SMD 0.17, 95% CI [ ...
Nudges for Statin Prescribing in Primary CareStatins have been demonstrated to be an effective tool for reducing the risk of CVD-related events and mortality, but statins are often not prescribed for ...
Two Randomized Controlled Trials of Nudges to Encourage ...For the non-visit-based nudge (Trial #2), the denominator for the primary outcome will include a randomly selected cohort of eligible patients assigned to PCPs ...
SUPER-LIPID-LBCT-distribution_Alexander-Fanaroff.pdfResults – cluster RCT of non-visit-based intervention. Baseline characteristics. Intervention Usual care. (n = 975). (n = 975) p value. Age 63.3 ± 10.3 64.6 ...
Encouraging Pharmacist Referrals for ...In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with ...
Centralized Statin Prescribing Strategies for High CholesterolThis N/A medical study run by University of Pennsylvania needs participants to evaluate whether Non-visit Based Intervention and Visit-Based Intervention ...
Two randomized controlled trials of nudges to encourage ...SUPER LIPID is a pair of pragmatic clinical trials assessing the effectiveness of two strategies to encourage referral of appropriate patients to a centralized ...
Encouraging Pharmacist Referrals for Evidence-Based ...Statins are inexpensive, well tolerated, and substantially reduce cardiovascular events in patients at high risk, but most individuals in the US ...
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