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 prescribing behavior. The change involved switching the system default for statin prescribing to a 90-day supply with three refills unless the provider opted out.

More than 18,000 statin prescriptions from November 2022 to January 2024, when the default was in place, were evaluated in comparison to statin prescriptions in the preceding months and to a common medication whose prescription default did not change.

Impact

With the default in place, statin prescriptions for a 90-day supply rose to 92 percent – a 20 percentage point jump. 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. For Hispanic patients, the gap was reduced by more than half.

The 90-day default has been scaled across Penn Medicine.