Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

Markovitz, Adam A.; Holleman, Rob; Hofer, Timothy P.; Kerr, Eve A.; Klamerus, Mandi L.; Sussman, Jeremy B.

doi:10.1111/1475-6773.12788

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…When it comes to extrapolating the results, one has to bear in mind the fact that the Spanish health system finances practically all me-too drugs at an out-of-hospital level, and this is not necessarily the case elsewhere, e.g. in countries such as the USA or New Zealand [35][36][37].…”

Section: Advantages and Limitationsmentioning

confidence: 99%

Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

2020

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Background Hospital drug formularies are reduced lists of drugs designed to optimise inpatient care. Adherence to the drugs included in such formularies is not always 100% but is generally very high. Little research has targeted the impact of a change in these formularies on outpatient drug prescriptions. This study therefore sought to evaluate the impact of a change affecting bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions in a region in north-western Spain. Two new drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention. Methods We used a natural before-after quasi-experimental design with control group based on monthly data. The intervention evaluated was the modification of a hospital drug formulary, which involved withdrawing salmeterol/fluticasone in order to retain formoterol/budesonide as the sole inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). Using official data sources, we extracted the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed-days, and cost per DDD. Results Intra-hospital use showed a 173.2% rise (95% CI 47.3–299.0%) in the medication retained in the formulary, formoterol/budesonide, and a 94.9% drop (95% CI 77.9–111.9%) in the medication withdrawn from the formulary, salmeterol/fluticasone. This intervention led to an immediate reduction of 75.9% (95% CI 82.8–68.9%) in the intra-hospital cost per DDD of ICS/LABA. No significant changes were observed in out-of-hospital use. Conclusions Although this intervention was cost-effective in the intra-hospital setting, the out-of-hospital impact of a change in the drug formulary cannot be generalised to all types of medications and situations.

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Section: Advantages and Limitationsmentioning

confidence: 99%

Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

2020

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“…Despite this, multiple studies have shown that patients’ risk still plays almost no role in current clinical decision-making in CVD prevention [ 1 – 3 , 14 , 15 , 20 , 21 ]. This is not entirely surprising, since guidelines alone have repeatedly been shown to be inadequate in driving wide-spread implementation of new practices [ 1 , 12 , 20 , 22 ]. Tools to help encourage the use of these guidelines, and to improve cardiovascular prevention in high-risk patients, have had an effect, but only a small one [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding providers’ attitudes and key concerns toward incorporating CVD risk prediction into clinical practice: a qualitative study

Takamine

Forman

Damschroder

et al. 2021

BMC Health Serv Res

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Background Although risk prediction has become an integral part of clinical practice guidelines for cardiovascular disease (CVD) prevention, multiple studies have shown that patients’ risk still plays almost no role in clinical decision-making. Because little is known about why this is so, we sought to understand providers’ views on the opportunities, barriers, and facilitators of incorporating risk prediction to guide their use of cardiovascular preventive medicines. Methods We conducted semi-structured interviews with primary care providers (n = 33) at VA facilities in the Midwest. Facilities were chosen using a maximum variation approach according to their geography, size, proportion of MD to non-MD providers, and percentage of full-time providers. Providers included MD/DO physicians, physician assistants, nurse practitioners, and clinical pharmacists. Providers were asked about their reaction to a hypothetical situation in which the VA would introduce a risk prediction-based approach to CVD treatment. We conducted matrix and content analysis to identify providers’ reactions to risk prediction, reasons for their reaction, and exemplar quotes. Results Most providers were classified as Enthusiastic (n = 14) or Cautious Adopters (n = 15), with only a few Non-Adopters (n = 4). Providers described four key concerns toward adopting risk prediction. Their primary concern was that risk prediction is not always compatible with a “whole patient” approach to patient care. Other concerns included questions about the validity of the proposed risk prediction model, potential workflow burdens, and whether risk prediction adds value to existing clinical practice. Enthusiastic, Cautious, and Non-Adopters all expressed both doubts about and support for risk prediction categorizable in the above four key areas of concern. Conclusions Providers were generally supportive of adopting risk prediction into CVD prevention, but many had misgivings, which included concerns about impact on workflow, validity of predictive models, the value of making this change, and possible negative effects on providers’ ability to address the whole patient. These concerns have likely contributed to the slow introduction of risk prediction into clinical practice. These concerns will need to be addressed for risk prediction, and other approaches relying on “big data” including machine learning and artificial intelligence, to have a meaningful role in clinical practice.

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“…8 It is estimated that as many as 475 000 future cardiovascular events could be prevented if statins were assigned to all those who exceeded the ≥7.5% cutoff in 10-year ASCVD risk in the 40 to 75 years range. 8 Several reports on statin prescriptions (behavioral change 3,[9][10][11] and total or LDL-cholesterol (physiological responses to the behavioral change 3,4 ) trends proximal to the ACC/AHA guideline release suggest the recommendations have had less impact than anticipated. Although improved LDL-cholesterol levels are no longer the clinical goal following the "treat to ASCVD risk" from the "treat to LDL-cholesterol target" paradigm change, the substantial expansion of the eligible population and shift to moderate-and high-intensity statin therapy should have reduced LDL-cholesterol concentrations nationally.…”

mentioning

confidence: 99%

Trends in low‐density lipoprotein‐cholesterol blood values between 2012 and 2017 suggest sluggish adoption of the recent 2013 treatment guidelines

Superko¹,

Williams²,

Dansinger

et al. 2018

Clinical Cardiology

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Background: Over a 14-year period, age-adjusted high total cholesterol (≥240 mg/dL) in the United States declined from 18.3% in 1999 to 2000 to 11.0% in 2013 to 2014, coinciding with the 2001 National Cholesterol Education Program Adult Treatment Panel (ATP)-III guidelines that endorsed low-density lipoprotein (LDL)-cholesterol blood value goals. Statin treatment recommendations were revised by the American College of Cardiology and the American Heart Association (ACC/AHA) in November 2013 to a "risk-based prescription" approach that did not utilize blood cholesterol values. This increased dosage and expanded the statin-eligible population by an estimated 12.8 million US adults. These changes should further lower total and LDL cholesterol concentrations nationally. Methods: We examined data from 507 752 patients nationally aged ≥16 years whose fasting bloods were sent to Boston Heart Diagnostics for direct LDL-cholesterol measurements. Between 2012 and 2017, age-adjusted concentrations were examined by analysis of covariance and LDL-cholesterol ≥160 mg/dL by logistic regression. Results: Contrary to expectations, age-adjusted mean LDL-cholesterol concentrations (AESE, mg/dL) increased significantly (P < 10

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Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

Abstract: Addition of a high-potency statin to formulary affected provider prescribing more than the ACC/AHA guidelines.

Cited by 10 publications

References 28 publications

Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

Understanding providers’ attitudes and key concerns toward incorporating CVD risk prediction into clinical practice: a qualitative study

Trends in low‐density lipoprotein‐cholesterol blood values between 2012 and 2017 suggest sluggish adoption of the recent 2013 treatment guidelines

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