Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials.

Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.

临床医生时间有限，缺乏系统性的预防保健努力，这可能是导致他汀类药物处方存在差距的原因。

Background

To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management.

确定两项干预措施对将适当患者转诊给药剂师进行脂质管理的他汀类药物处方的影响。

DESIGN, SETTING, AND PARTICIPANTS: These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system.

设计、环境和参与者：这两项实用的群组随机临床试验在社区卫生系统中的12个初级保健实践中进行。

Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics.

试验1采用延迟干预设计，是一种基于访问的干预措施，在单一诊所内按临床医生级别进行随机分组；试验2是一种并行组试验，采用异步干预措施，在11个诊所内按诊所级别进行随机分组。

Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion.

被分配到参与实践的初级保健临床医生处的患者，如果有高强度或中等强度他汀类药物的适应症，并且要么未被开具他汀类药物处方，要么被开具了不适当的低剂量他汀类药物处方，均符合纳入标准。

intervention

Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit.

试验1测试了一种在符合条件的患者就诊期间出现的中断性电子健康记录警报，该警报促进了向药剂师的转诊，而试验2测试了一项由研究团队下达的药剂师转诊订单，由初级保健临床医生在不考虑诊所就诊时间的情况下共同签署。

main_outcome_and_measure

The primary outcome was the proportion of patients prescribed a statin.

主要结果是被开具他汀类药物处方的患者比例。

Results

Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2.

总体而言，试验1中纳入了1412名患者，试验2中纳入了1950名患者。

Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female.

在两项试验中，患者的平均年龄为65.6（标准差9.9）岁，其中1485名患者（占44.2%）为女性。

Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4).

基线时主要心血管事件的10年平均风险为17.9%（标准差9.4%）。

In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3).

在试验1中，与常规护理相比，中断提醒并未显著增加他汀类药物的处方率（15.6%对比11.6%；未调整的绝对差异为3.9个百分点；95%置信区间，-0.4至8.3）。

In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1).

在试验2中，半自动化的药剂师转诊与常规护理相比，使他汀类药物的处方增加了16个百分点（31.6%对比15.2%；未调整的绝对差异为16.4个百分点；95%置信区间，12.7-20.1）。

conclusions_and_relevance

In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase.

在这两项群组随机临床试验中，基于访问的中断性提醒与常规护理相比，并未显著增加他汀类药物的处方，而一种异步半自动化的药剂师共同管理转诊策略与之相比则显著增加了他汀类药物的处方。

This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at high risk.

这种异步半自动化的药剂师参与血脂管理的转诊策略可能是一种可扩展且有效的提高高风险患者他汀类药物处方的方法。

trial_registration

ClinicalTrials.gov Identifier: NCT05537064.

ClinicalTrials.gov 标识符：NCT05537064。