Title: Statin Use and Quality Control in an Urban Primary Care Clinic Authors: Hanyuan Shi, MD. Jennifer Hong, BA. Henri Wathieu, BA. Kevin Tea, BA. Kristin
Bateman, MD. Background:
Atherosclerotic cardiovascular disease (ASCVD) risk assessment is important for primary prevention; although there are many different perspectives to lipid control, the outpatient primary care physician has a large role in prescribing statins for patients. Epidemiologic studies of clinics have shown poor ASCVD risk documentations; we show an initiative in an urban PCP teaching clinic to enhance physician awareness. Objective: To determine rates of physician documentation of ASCVD risk scores for patients as well as quality of statin prescriptions. Methods: We collected and analyzed consecutive visits within four months from August 2019 to November 2019 at our urban primary care residents’ clinic. Inclusion criteria included patients ages 40-75, with no previous history of coronary artery disease, myocardial infarction, cerebrovascular incident, or peripheral arterial disease as documented in the electronic medical record. Primary endpoint was documentation of ASCVD risk score in physician note. Secondary endpoints included lipid panel within one year, correct ASCVD documentation (based on pooled cohort 10-year risk developed by Blumenthal published by ACC), and statin prescription. Results: There was a total of 772 eligible patients and visits in our dataset. The average age was 57.6 years old with 60.5% female, 65.8% African-American. Patients had on average several comorbid conditions; 40.4% were diabetic, 49.9% were former or current smokers, and 74.1% had hypertension. Out of these visits, there were only 292 (37.8%) that had ASCVD risk documented. These ranged from 0.4% to 54.3%. This did not vary significantly based on the specific month of visit. Furthermore, out of 140 patients who had documented ASCVD scores of over 10%, 62 patients (44.3%) were not on any kind of statin. Conclusions: At an urban primary care clinic, there was low physician documentation of ASCVD risk for primary prevention for indicated patients. This translated to a significant proportion of patients with high ASCVD without statin use. Strategies have been formulated including EPIC dotphrase, nursing prompting, and pre-clinic reminders to improve ASCVD use and discussion with patients.
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