Abstract 17514: Changing Default Prescription Length to Reduce Barriers to Statin Adherence

Abstract

Introduction: Statins substantially reduce cardiovascular risk, yet adherence is suboptimal. 90-day prescription fills are associated with better adherence than 30-day fills, though many prescriptions are not written for 90 days. We evaluated the effect of changing default prescription length to 90 days within the electronic health record (EHR) on the proportion of statin prescriptions written for 90 days. Methods: At a single academic health system, we changed the default duration for statin prescriptions written using the primary care preference list within the EHR to 90 pills with 3 refills, while still allowing providers to make a manual change. We compared the proportion of prescriptions written for 90 days over the 4 months before the change (pre-intervention) and 4 months after the change (post-intervention) using a chi-square test, along with need to change prescription dose or drug during the 90-day period after the prescription was written, a potential unintended consequence. Results: Among statin prescriptions written using the primary care prescription preference list, the rate of prescriptions written for 90 days increased from 70.6% pre-intervention to 90.1% post-intervention (p<0.001). Pre-intervention, patients with Medicaid insurance, median ZIP code household income < $50,000, and Black race were significantly less likely to be prescribed a 90-day statin supply (p <0.05). The intervention increased the proportion of 90-day prescriptions more in these groups (interaction p < 0.01), and they were no longer less likely to be prescribed a 90-day supply in the post-intervention period. Post-intervention, there was no change in the proportion of patients that needed a change in prescription during the active prescription time period (p=0.15). Conclusion: Changing default options significantly increased the proportion of statin prescriptions written for 90 days and closed baseline equity gaps without restricting patient or physician choice.