Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis

Implementation Science

Lauren H. Yaeger¹  Michael R. Gionfriddo²  Christina Gregor²  Thomas J. Waltz³  Alanna K. Rahm⁴  Marc S. Williams⁴  Laney K. Jones⁴  Samuel S. Gidding⁴  Stephanie Tilberry⁴  Amy C. Sturm⁴  Yirui Hu⁵  Ross C. Brownson⁶  Terry L. Seaton⁷  Anne Goldberg⁸ 

[1] Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA;Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA;Eastern Michigan University, Ypsilanti, MI, USA;Genomic Medicine Institute, Geisinger, 100 N Academy Ave., 17822, Danville, PA, USA;Population Health Sciences, Geisinger, Danville, PA, USA;Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA;Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA;Population Health, Mercy Clinic—East Communities, St. Louis, MO, USA;Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA;

关键词: Statin;    Hypercholesterolemia;    Implementation strategies;    Uptake;    Meta-analysis;   

DOI  :  10.1186/s13012-021-01108-0

来源: Springer

【 摘 要 】

BackgroundNumerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins.Methods and resultsThis systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1–13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] − 0.17, 95% CI − 0.27 to − 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes.ConclusionAlthough studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes.Trial registrationPROSPERO CRD42018114952.

【 授权许可】

CC BY