Cardiovascular Diseases
Conditions
Brief summary
In this study, the investigators will conduct a pragmatic, cluster-randomized, controlled trial to evaluate an active choice intervention with and without social comparison feedback to increase physician statin prescribing rates for eligible patients.
Detailed description
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Strong evidence indicates that statin medications can reduce the risk of CVD and for those with CVD statins have been shown to reduce mortality. Despite this evidence, statins are under-prescribed. In this study, the investigators will test the effectiveness of nudges targeted to physicians using active choice and social comparisons feedback to increasing the rate at which statin medications are prescribed to patients eligible based on national practice guidelines.
Interventions
BEHAVIORALActive choice
Statin options are framed to physicians as an active choice to prescribe or not prescribe a statin
BEHAVIORALSocial comparison feedback
Statin prescribing rates are communicated to physicians and along with how their performance compares to their peers
Sponsors
University of Pennsylvania
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
* Patient has a primary care physician at University of Pennsylvania Health System * Patient meets 2013 AHA/ACC guidelines for statin therapy but no record of a statin prescription in the electronic health record
Exclusion criteria
* Patient has an allergy or adverse reaction to statins documented in the electronic health record * Patient has glomerular filtration rate less than 30 mL/min * Physicians (and their respective patients) will be excluded if they have less than 10 patients among their entire panel that are eligible for a statin
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Statin Prescribing Rate | Two Months | Percentage of patients eligible for a statin that have been prescribed a statin |
Countries
United States
Participant flow
Recruitment details
No informed consent was obtained from the participants in this study.
Participants by arm
| Arm | Count |
|---|---|
| Control No intervention | 1,566 |
| Active Choice Physicians will be asked to review a list of their patients eligible for statin therapy who are not yet prescribed a statin and make an active choice whether or not to prescribe a statin.
Active choice: Statin options are framed to physicians as an active choice to prescribe or not prescribe a statin | 1,743 |
| Active Choice With Social Comparison Feedback Physicians will be asked to review a list of their patients eligible for statin therapy who are not yet prescribed a statin and make an active choice whether or not to prescribe a statin. Physicians will receive social comparison feedback informing them of how their performance compares to their peers
Active choice: Statin options are framed to physicians as an active choice to prescribe or not prescribe a statin
Social comparison feedback: Statin prescribing rates are communicated to physicians and along with how their performance compares to their peers | 1,465 |
| Total | 4,774 |
Baseline characteristics
| Characteristic | Control | Active Choice | Active Choice With Social Comparison Feedback | Total |
|---|---|---|---|---|
| Age, Continuous | 62.1 years STANDARD_DEVIATION 8.5 | 62.4 years STANDARD_DEVIATION 8.2 | 62.5 years STANDARD_DEVIATION 8.2 | 62.4 years STANDARD_DEVIATION 8.3 |
| Annual Household Income >100,000 US$ | 341 Participants | 206 Participants | 312 Participants | 859 Participants |
| Annual Household Income 50,000 - 100,000 US$ | 784 Participants | 960 Participants | 733 Participants | 2477 Participants |
| Annual Household Income <50,000 US$ | 435 Participants | 563 Participants | 406 Participants | 1404 Participants |
| Annual Household Income Missing | 6 Participants | 14 Participants | 14 Participants | 34 Participants |
| Race/Ethnicity, Customized Black non-Hispanic | 420 Participants | 479 Participants | 419 Participants | 1318 Participants |
| Race/Ethnicity, Customized Other | 142 Participants | 154 Participants | 120 Participants | 416 Participants |
| Race/Ethnicity, Customized White non-Hispanic | 1004 Participants | 1110 Participants | 926 Participants | 3040 Participants |
| Sex: Female, Male Female | 738 Participants | 710 Participants | 701 Participants | 2149 Participants |
| Sex: Female, Male Male | 828 Participants | 1033 Participants | 764 Participants | 2625 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 1,566 | 0 / 1,743 | 0 / 1,465 |
| other Total, other adverse events | 0 / 1,566 | 0 / 1,743 | 0 / 1,465 |
| serious Total, serious adverse events | 0 / 1,566 | 0 / 1,743 | 0 / 1,465 |
Outcome results
Primary
Statin Prescribing Rate
Percentage of patients eligible for a statin that have been prescribed a statin
Time frame: Two Months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Control | Statin Prescribing Rate | 40 Participants |
| Active Choice | Statin Prescribing Rate | 116 Participants |
| Active Choice With Social Comparison Feedback | Statin Prescribing Rate | 117 Participants |