Opportunity

Cardiovascular disease is the leading cause of death in the United States. Statins lower cholesterol and reduce the risk of myocardial infarction by 30 percent. Still, even among patients who have had a heart attack, nearly half stop taking their statin medications within a year of their initial prescription.

The need to refill prescriptions contributes to non-adherence, as the process involves logistical and cognitive barriers, including transport, time, and effort. Increasing prescription length from 30 to 90 days is associated with better adherence to cardiovascular medications, but many patients are not prescribed a 90-day supply.

Not only is improving cardiovascular outcomes important for patient health, it is also financially significant to health systems with value-based contracts.

Intervention

With support from the Nudge Unit, a team of researchers at the University of Pennsylvania tested whether a simple change in the electronic health record could improve statin medication adherence. The change involved switching the system default for statin prescribing to a 90-day supply with three refills unless the provider opted out.

Impact

A pilot study showed that the rate of prescriptions for 90 days rose to 90 percent with the default in place, compared to 71 percent before the intervention. The new default also eliminated an equity gap: patients who were Black, on Medicaid, or lived in lower income zip codes were less likely to be prescribed a 90-day statin supply in the pre-intervention period but not while the 90-day default was active.

As a result of this success, the 90-day default has been scaled across Penn Medicine.