Putting ‘nudges’ in medical notes encourages accurate statin prescriptions

PUSHING doctors to put heart patients on cholesterol-lowering statins increases uptake, according to new research.

Embedding “nudges” into electronic healthcare records meant more were prescribed the drugs at the right dosages.

Each prompt was tailored to flag those with hardening of the arteries that can lead to heart attack or stroke causing blood clots.

About six million Britons take statins regularly – but health experts claim they are under prescribed. Senior author Dr Mitesh Patel, of the University of Pennsylvania, said: “Active choice prompts are used commonly in electronic health records. But they often are not rigorously tested head-to-head against other approaches.

“By systematically testing these interventions we can build upon the approaches that do work and turn off the ones that don’t.”

His team tested a “passive choice” notification doctors had to navigate to and an “active” pop-up prompting a prescription for a certain dose they had to accept or dismiss.

The six-month clinical trial included 82 cardiologists and more than 11,000 of their patients randomly split into three groups.

One used the active choice, another the passive choice and the last went without either nudge, serving as a control.

There was a four per cent rise in optimal statin prescribing in patients already diagnosed if their doctors were in the active arm.

First author Dr Srinath Adusumalli, also at the University of Pennsylvania, said: “Active choice prompts led to small increases in prescribing the right dose of statins for patients at highest risk – those who already had atherosclerotic heart disease.

“These are the types of patients who stand to benefit the most from statin therapy with regard to reduction in major adverse cardiovascular events, like a heart attack, and mortality.”

For at-risk patients who did not yet have it, there were no significant differences in prescription rates, no matter what arm of the study they were in. Analysis showed 42.6% of the control group, 40.6% in the passive and 44.5% in the active received statin prescriptions in the optimal amount.

When examining whether the patients with heart disease received any statin prescriptions at all there was little difference..