Patient and physician predictors of hyperlipidemia screening and statin prescription.

Kannan S, Asch DA, Kurtzman GW, Honeywell S, Day SC, Patel MS. Patient and physician predictors of hyperlipidemia screening and statin prescription. The American journal of managed care. 2018 Aug 1; 24(8):e241-e248.

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Abstract:

OBJECTIVES: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription. STUDY DESIGN: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System. METHODS: Data on patients, screening orders, and prescriptions were obtained from the electronic health record. Multivariate logistic regression models were fit to binary outcomes of lipid screening and statin prescription. RESULTS: Among 97,189 eligible patients, 79.9% had an order for hyperlipidemia screening. In adjusted models, significant patient predictors of greater odds of having screening ordered included a history of diabetes (odds ratio [OR], 1.19; 95% CI, 1.10-1.29; P < .001) or hypertension (OR, 1.16; 95% CI, 1.10-1.23; P < .001). Significant provider predictors of lower odds of having screening ordered were being a resident PCP (OR, 0.63; 95% CI, 0.43-0.93; P = .021) or being trained in family medicine (OR, 0.37; 95% CI, 0.30-0.47; P < .001). Among 40,845 eligible patients, 56.1% were prescribed a statin. In adjusted models, significant patient predictors of greater odds of being prescribed a statin were if they had a history of diabetes (OR, 2.70; 95% CI, 2.32-3.13; P < .001) or clinical cardiovascular disease (OR, 2.26; 95% CI, 1.85-2.76; P < .001). Significant provider predictors of lower odds of being prescribed a statin were being a physician assistant (OR, 0.65; 95% CI, 0.52-0.81; P < .001) or female (OR, 0.82; 95% CI, 0.70-0.96; P = .01). CONCLUSIONS: Both patient and provider factors significantly predicted guideline-concordant care for hyperlipidemia screening and statin therapy.