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Meta-Analysis
. 2021 Apr 13;16(1):40.
doi: 10.1186/s13012-021-01108-0.

Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis

Laney K Jones  1 , Stephanie Tilberry  2 , Christina Gregor  3 , Lauren H Yaeger  4 , Yirui Hu  5 , Amy C Sturm  2 , Terry L Seaton  6   7 , Thomas J Waltz  8 , Alanna K Rahm  2 , Anne Goldberg  9 , Ross C Brownson  10   11 , Samuel S Gidding  2 , Marc S Williams  2 , Michael R Gionfriddo  3
Affiliations
Meta-Analysis

Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis

Laney K Jones et al. Implement Sci. .

Abstract

Background: Numerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins.

Methods and results: This systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1-13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] - 0.17, 95% CI - 0.27 to - 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes.

Conclusion: Although studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes.

Trial registration: PROSPERO CRD42018114952 .

Keywords: Hypercholesterolemia; Implementation strategies; Meta-analysis; Statin; Uptake.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Forest plot of implementation strategies’ impact on LDL-C compared to control. a Achievement of target LDL-C. b Standardized mean difference in LDL-C
Fig. 3
Fig. 3
Forest plot of implementation strategies’ impact on statin prescribing compared to control
Fig. 4
Fig. 4
Forest plot of implementation strategies’ impact on statin adherence compared to control. a Medication possession ratio or portion of days covered > 80%. b Standardized mean difference in medication possession ratio or portion of days covered
Fig. 5
Fig. 5
Risk of bias of RCTs included in the meta-analyses
See this image and copyright information in PMC

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