Category: Federal Forum Posters
Purpose: Healthcare systems are increasingly evaluated by the quality of patient outcomes with the shift from fee-for-service to value-based care model. Despite evidence supporting statin use to reduce the risk of atherosclerotic cardiovascular disease (ASCVD), suboptimal use persists in one-third of patients with diabetes. Consequently, quality measures have been developed to address statin utilization and to improve adherence to guidelines in health care facilities. The purpose of this medication use evaluation was to assess underutilization of statins in treatment-experienced patients with type 2 diabetes and describe improvement opportunities.
Methods: A retrospective chart review was conducted to evaluate possible causes for non-statin use in statin-experienced patients with diabetes. An electronic list of patients from the New Mexico Veterans Affair Health Care System (NMVAHCS) with a documented diagnosis of type 2 diabetes and an inactive statin prescription was generated. The inclusion criteria encompassed patients 40 years of age or older with a diagnosis of type 2 diabetes after July 1, 2015, and with a past history of statin use but without an active statin prescription at the time of the chart review. Patients were excluded if they had pre-diabetes, a diagnosis of diabetes prior to July 1, 2015, or had a statin prescription filled within the last 4 months. The primary outcome measure was reason patient was no longer receiving active statin therapy. Reasons included missed opportunities (recent provider visit without renewal), reports of non-adherence, loss to follow-up, and adverse drug reactions. Secondary outcomes included ASCVD risk score, time since last lipid panel and provider visit, and use of alternative lipid-lowering therapy.
Results: From the convenience sample of 268 patients, 34 patients met the inclusion criteria for analysis. Seventy-six percent of the patients had a 10-year ASCVD risk greater than 7.5% as calculated by the American College of Cardiology/American Heart Association (ACC/AHA) risk estimator. Three patients (8.8%) were no longer receiving statin therapy due to a previous adverse drug reaction, in which 2 patients were never re-challenged. Overall, the majority of patients (91.2%) had an expired prescription for statin therapy that was not renewed. Reasons for expired prescriptions comprised of missed opportunities (32.3%), reports of non-adherence (16.1%), and loss to follow-up (25.8%). In patients who were seen by a primary care provider in the last 12 months, 23.9% did not have a lipid panel drawn during that time. Furthermore, only 9% of the patients had previous use of an alternative lipid-lowering therapy, such as niacin and ezetimibe.
Conclusion: The majority of treatment-experienced patients with type 2 diabetes were no longer on statin therapy due to expiration of their statin prescription. Patients with no prior adverse drug reactions to statins are candidates for re-initiation of statin therapy based on their ASCVD risk score. Opportunities for improvement to increase utilization of statins in patients with type 2 diabetes include developing patient education tools regarding statin benefits and medication refill processes, improving documentation of reasons for non-active statin, and expanding the use of population health management.
Sang Wan Kim– PGY1 Pharmacy Resident, New Mexico VA Health Care System, Albuquerque, NM