A simple nudge leads to more statin prescriptions and better health

With a simple click, doctors can potentially save lives and reduce heart attack and stroke risks for thousands of patients by helping them have their statins on hand. Researchers "nudged" doctors toward this through a default change in the electronic health record that made prescribing a 90-day supply of the medication the default option instead of actively choosing a 30-day supply. The study, from the Perelman School of Medicine at the University of Pennsylvania, was published this month in JAMA Internal Medicine.

For patients managing chronic conditions, this simple change just makes life easier by eliminating eight pharmacy trips annually per medication and reducing chances to be late or forgetting to refill. With time, I hope this will translate into closing gaps in hypertension control and other chronic diseases that statins treat."

Corinne Rhodes, MD, MPH, co-author, associate professor of General Internal Medicine and the medical director of Population Health at the University of Pennsylvania Health System 

Making the right choice the easy choice 

Previous research indicated that patients with hardened arteries who only took their statins roughly half of the time were 30 percent more likely to die than those who took their medications regularly.

However, another study showed that, even among patients with previous heart attacks, only about 64 percent regularly took statin medications. The number was even smaller-38 percent-among those with diabetes. 

A nudge is a behavioral science-informed approach to guiding people toward a desired outcome but the key is making that choice desirable and trouble-free. 

"Making the right choice the easy choice is a core tenet of nudging. What's exciting is that this small change requiring zero additional work on the part of clinicians could have such a profound impact," said senior author M. Kit Delgado, MD, MS, faculty director of the Nudge Unit and an associate professor of Emergency Medicine and Epidemiology. 

At the start of the study in 2022, roughly 71 percent of the participating physicians at Penn Medicine prescribed 90-day supplies of statins. By the end of the study in 2024, 91 percent of the participating doctors were ordering 90-day prescriptions instead of actively choosing the other option for 30-day supplies. 

Ultimately, the study resulted in 7,200 fewer 30-day prescriptions. And due to the success seen in the statin nudge, the change in default toward longer prescriptions was broadened at Penn Medicine to include some blood pressure and diabetes medications , as well.

Considering access for all 

In addition to the overall 20 point swing in longer prescriptions, the researchers also saw closures in demographic disparities related to prescription length. 

Before the nudges, Hispanic and Black patients, as well as those living in zip codes where the average household income was under $50,000, were significantly less likely to receive 90-day statin prescriptions. For example, while well over 70 percent of non-Hispanic white patients' doctors were writing 90-day prescriptions, just above 50 percent of non-white Hispanic patients'' doctors were, and just roughly 67 percent of Black patients' doctors were, too.

Once the study finished, though, 90 percent or more of all patients' doctors were writing statin prescriptions for 90-day supplies, regardless of how low the baseline rate had been.

"What makes this intervention particularly powerful is how it eliminated these disparities completely," said co-author Alexander Fanaroff, MD, an assistant professor of Cardiovascular Medicine. "By the study's conclusion, approximately 90 percent of patients across all demographic groups received the longer prescriptions, demonstrating how we can advance health equity without requiring additional resources."