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Kannan S, Asch DA, Kurtzman GW, Honeywell S, Day SC, Patel MS. Patient and physician predictors of hyperlipidemia screening and statin prescription. The American journal of managed care. 2018 Aug 1; 24(8):e241-e248.
OBJECTIVES: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription. STUDY DESIGN: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System. METHODS: Data on patients, screening orders, and prescriptions were obtained from the electronic health record. Multivariate logistic regression models were fit to binary outcomes of lipid screening and statin prescription. RESULTS: Among 97,189 eligible patients, 79.9% had an order for hyperlipidemia screening. In adjusted models, significant patient predictors of greater odds of having screening ordered included a history of diabetes (odds ratio [OR], 1.19; 95% CI, 1.10-1.29; P < .001) or hypertension (OR, 1.16; 95% CI, 1.10-1.23; P < .001). Significant provider predictors of lower odds of having screening ordered were being a resident PCP (OR, 0.63; 95% CI, 0.43-0.93; P = .021) or being trained in family medicine (OR, 0.37; 95% CI, 0.30-0.47; P < .001). Among 40,845 eligible patients, 56.1% were prescribed a statin. In adjusted models, significant patient predictors of greater odds of being prescribed a statin were if they had a history of diabetes (OR, 2.70; 95% CI, 2.32-3.13; P < .001) or clinical cardiovascular disease (OR, 2.26; 95% CI, 1.85-2.76; P < .001). Significant provider predictors of lower odds of being prescribed a statin were being a physician assistant (OR, 0.65; 95% CI, 0.52-0.81; P < .001) or female (OR, 0.82; 95% CI, 0.70-0.96; P = .01). CONCLUSIONS: Both patient and provider factors significantly predicted guideline-concordant care for hyperlipidemia screening and statin therapy.