Pharmacist-to-prescriber intervention to close therapeutic gaps for statin use in patients with diabetes: A randomized controlled trial

Abstract

Objective: To assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy.

Design: The Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication.

Setting: This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard.

Participants: In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy.

Intervention: The control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin.

Main outcome measures: The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type.

Results: The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was "Patient has normal cholesterol" and this caused the greatest amount of discussion between pharmacist and prescriber.

Conclusion: Through a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care.