VHAN Statin Outreach Project Demonstrates Value of Collaboration

VHAN’s Statin Outreach Service outcomes have been published in the American Diabetes Association’s journal Clinical Diabetes. The paper (available here) was e-published in May 2020 with print to follow in a future edition. This program demonstrated a successful strategy for improving quality of care for people with diabetes and/or cardiovascular conditions. VHAN’s pharmacist-led program was aimed at improving rates of statin use among appropriate patients in high-risk populations. This intervention was unique in that it used a population health team to identify patients, then provided support to primary care physicians (PCPs) and patients to improve the measure of statin use by utilizing the population health clinical pharmacy team.

There is strong evidence that statin medications reduce cardiovascular risk in patients with diabetes or preexisting heart disease. However, despite evidence-based recommendations for their use, statins are both under-prescribed and underutilized.

The statin outreach service was piloted in the Vanderbilt Medical Group, and patients were included if they had seen a VUMC PCP, were 40–75 years of age, had type 2 diabetes and/or atherosclerotic cardiovascular disease (ASCVD), and had not filled any statin prescription in the past six months.

The intervention period was conducted over about six weeks in February and March 2018. The post-intervention analysis was at least 12 months after the intervention for all patients. Seven of the 19 patients in the intervention group (36.8%) were adherent to statin therapy compared to 5.3% of that group before the intervention. For the control group, those who were not contacted by the pharmacist, seven of 38 patients (18.4%) had filled a statin prescription at least once at follow-up. 

As a result of the pilot, the network is now more proficiently using claims-based methods of patient identification and has adjusted its processes for engaging providers to work with patients with uncontrolled diabetes and patients recently discharged from an acute care setting. The collaborative work between pharmacists and providers on the care team have also led to substantial growth of clinical pharmacy services to help manage patients with complex chronic conditions.

“We found the method to be well-accepted in the primary care practice. We had the support of colleagues in primary care who acted as champions of the program and helped us to introduce it to the practice,” said Michelle Griffith, M.D., Associate Professor in VUMC’s Diabetes, Endocrinology, & Metabolism Division. Dr. Griffith helped design the intervention and wrote the study manuscript along with Christopher Terry, PharmD, CDCES, clinical pharmacist at VHAN; Erin Neal, PharmD, director of medication management at VHAN; Katelyn Daly, senior analytics consultant at VHAN; and Donna Skupien, RN, director of clinical program development at VHAN.

“Patients appreciated the fact that the pharmacist was working with their primary care doctor,” Dr. Griffith said. “We also believe that using the EMR to communicate and document fit into the clinic workflow more readily than other programs in which faxes or letters may be sent to indicate a care gap.”