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

Summary

Across two pragmatic cluster RCTs (n=1412 and n=1950), a visit-based interruptive EHR alert did not significantly increase statin prescribing versus usual care, whereas an asynchronous semiautomated pharmacist referral strategy increased prescribing by 16.4 percentage points (31.6% vs 15.2%). This scalable workflow leverages pharmacists to close preventive care gaps in high-risk patients.

Key Findings

• Visit-based interruptive EHR alerts did not significantly increase statin prescribing compared with usual care (15.6% vs 11.6%).
• Semiautomated pharmacist referral increased statin prescribing by 16.4 percentage points versus usual care (31.6% vs 15.2%).
• Trials enrolled 1412 and 1950 patients across 12 practices with mean 10-year ASCVD risk 17.9%.

Clinical Implications

Health systems should consider implementing asynchronous semiautomated pharmacist referrals for lipid management to increase appropriate statin prescribing in high-risk patients, rather than relying on interruptive alerts.

Limitations

• Single health system; generalizability may be limited
• Outcome focused on prescribing, not downstream clinical events

Future Directions

Evaluate long-term adherence and clinical outcomes, and test scalability across diverse health systems and payers.