Martinez Kathryn A, Montori Victor M, Rodriguez Fatima, Tereshchenko Larisa G, Kovach Jeffrey D, Boyer Christopher, Hurwitz Heather McKee, Rothberg Michael B
Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA.
Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
Med Decis Making. 2025 Jun 24:272989X251346508. doi: 10.1177/0272989X251346508.
BackgroundStatin Choice is a shared decision-making encounter tool embedded in the electronic health record.ObjectiveTo describe the association between the use of Statin Choice, statin prescriptions by clinicians, prescription fills (primary adherence), and statin adherence at 12 mo (secondary adherence).DesignObservational cohort study at the Cleveland Clinic Health System.SubjectsStatin-naïve adults aged 40 to 75 y with a 10-y atherosclerotic cardiovascular disease (ASCVD) risk of ≥5% and a primary care appointment between January 2020 and July 2021.Main MeasuresThe primary exposure was the use of Statin Choice during a clinical encounter. We measured whether the use of Statin Choice was associated with statin prescriptions. We measured statin adherence based on pharmacy fill data at 60 d (primary adherence) and 12 mo (secondary adherence). We used mixed-effects logistic regression to estimate the adjusted odds of statin prescriptions and adherence at the 3 time points by the use of Statin Choice.Key ResultsAmong 17,001 statin-naïve patients, 13% viewed Statin Choice and 7% were prescribed a statin. The median ASCVD risk was 10%. Patients who were shown Statin Choice had 9.04 higher odds of being prescribed a statin compared with patients not shown Statin Choice (95% confidence interval [CI]: 7.86-10.4). Among patients prescribed a statin, the use of Statin Choice was associated with 5.75 higher odds of primary adherence compared with usual care (95% CI: 4.22-7.83). At 12 mo, Statin Choice use was significantly associated with adherence in the unadjusted analysis (OR: 1.58; 95% CI: 1.05-2.08) but was not significant after adjustment for patient factors. Patients shown Statin Choice had an average of 12 mg/dL reduction in low-density lipoprotein cholesterol at 12 mo (95% CI: -16 mg/dL, -10) compared with those not shown Statin Choice.ConclusionIn this observational study, Statin Choice use was strongly associated with statin prescription and fills and weakly associated with adherence to statins for up to 1 y. A randomized trial is needed to confirm causality.HighlightsStatin Choice is an electronic health record-embedded shared decision-making encounter tool available for free in many health care systems.Small randomized controlled trials have found modest associations between the use of Statin Choice and statin adherence using patient-reported data.In our large study using pharmacy fill data, clinician use of Statin Choice during a medical encounter was associated with significantly greater patient adherence with statins up to 1 y later.Exposure to Statin Choice was associated with a significant reduction in low-density lipoprotein cholesterol over 1 y.
背景
“他汀类药物选择”是一种嵌入电子健康记录的共同决策会诊工具。
目的
描述“他汀类药物选择”的使用、临床医生开具他汀类药物处方、处方配药（初始依从性）与12个月时他汀类药物依从性（继发依从性）之间的关联。
设计
在克利夫兰诊所医疗系统进行的观察性队列研究。
研究对象
年龄在40至75岁之间、既往未服用过他汀类药物、10年动脉粥样硬化性心血管疾病（ASCVD）风险≥5%且在2020年1月至2021年7月期间进行过初级保健预约的成年人。
主要测量指标
主要暴露因素是在临床会诊期间使用“他汀类药物选择”。我们测量了使用“他汀类药物选择”是否与他汀类药物处方相关。我们根据60天（初始依从性）和12个月（继发依从性）时的药房配药数据测量他汀类药物依从性。我们使用混合效应逻辑回归来估计通过使用“他汀类药物选择”在3个时间点开具他汀类药物处方和依从性的调整后比值比。
关键结果
在17001名既往未服用过他汀类药物的患者中，13%查看了“他汀类药物选择”，7%被开具了他汀类药物处方。ASCVD风险的中位数为10%。与未查看“他汀类药物选择”的患者相比，查看了“他汀类药物选择”的患者被开具他汀类药物处方的几率高9.04倍（95%置信区间[CI]：7.86 - 10.4）。在被开具他汀类药物处方的患者中，与常规护理相比，使用“他汀类药物选择”与初始依从性几率高5.75倍相关（95% CI：4.22 - 7.83）。在12个月时，在未调整分析中，使用“他汀类药物选择”与依从性显著相关（OR：1.58；95% CI：1.05 - 2.08），但在对患者因素进行调整后不显著。与未查看 “他汀类药物选择” 的患者相比，查看了 “他汀类药物选择” 的患者在12个月时低密度脂蛋白胆固醇平均降低了12mg/dL（95% CI：-16mg/dL，-10）。
结论
在这项观察性研究中，使用“他汀类药物选择”与他汀类药物处方和配药密切相关，与长达1年的他汀类药物依从性弱相关。需要进行随机试验来确认因果关系。
要点
“他汀类药物选择”是一种嵌入电子健康记录的共同决策会诊工具，在许多医疗系统中可免费获取。小型随机对照试验发现，使用“他汀类药物选择”与使用患者报告数据得出的他汀类药物依从性之间存在适度关联。在我们使用药房配药数据的大型研究中，临床医生在医疗会诊期间使用“他汀类药物选择”与患者在长达1年后对他汀类药物的依从性显著提高相关。接触“他汀类药物选择”与1年内低密度脂蛋白胆固醇显著降低相关。
