Improving statin prescription through the involvement of nurses in the provision of ASCVD score: a quality improvement initiative in primary care

Alameddine, Reina; Seifeddine, Suzan; Ishak, Hala; Antoun, Jumana

doi:10.1080/00325481.2020.1755146

Cited by 2 publications

(1 citation statement)

References 31 publications

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“…For example, the use of a multi-component intervention targeting providers, including decision support, brief education, performance measures, and feedback, was shown to increase the adoption of statin prescription in primary care settings for the general population [ 42 ]. Another strategy may be team-based models, such as engaging nurses in initiating CVD risk assessment and providing recommendations [ 43 ], or bringing primary care providers into the clinic whose role is to manage complex non-AIDS comorbidities and provide primary care if preferred by the HIV provider [ 36 ].…”

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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Section: Discussionmentioning

confidence: 99%