Background: In 2013, ACC/AHA released new guidelines for cholesterol management. Historically, new guidelines can take up to a decade to diffuse into clinical practice, leading to suboptimal patient management. We hypothesized that systematic identification of barriers, and targeted interventions can improve management of cholesterol.
Objectives: To increase appropriate intensity statin prescription, as enumerated in the 2013 ACC/AHA guidelines, in all primary care clinic patients with atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus (DM), with an aim to make a 25% relative improvement from baseline (Dec’14) to Dec’ 15.
Methods: Information regarding statin use was obtained from the primary care clinic database. MD, NP and PharmD providers in the clinic were surveyed with an aim to understand the barriers to prescribing statins. A series of tailored interventions was subsequently deployed through multiple PDSA cycles, including pocket cards on statin guidelines, education sessions and EMR generated lists of patients who were not on a statin as per guidelines.
Result: Baseline data showed that 59.7% (238 of 398) patients with ASCVD were on an appropriate dose statin, while 70.7% (619 of 875) patients with DM were on an appropriate dose statin. Post intervention results after 12 months showed a 8.4% relative increase (258 of 398) in appropriate dose statin use amongst patients with ASCVD and a 2.1% relative increase (632 of 875) in patients with DM.
Conclusions and implication: A targeted strategy of PDSA cycles can increase the rates of statin usage, and lead to quicker uptake of ACC/AHA guidelines on cholesterol management.