Statin Prescriptions Vary Based on Appointment Time

Clinicians are less likely to prescribe cholesterol-lowering statins to patients with appointments later in the day, according to the results of a recent study.¹

The researchers examined how appointment times impacted the level of care patients received in primary care practices in order to better understand why statins continue to be underprescribed in US adults with heart disease.

Included in the study were more than 10,000 adults who had visited 1 of 28 primary care practices between March 2019 and February 2020. To be included in the study, the patients must have had a condition that would require the use of statins and a medication that lowers low-density lipoprotein cholesterol levels, which would benefit conditions such as atherosclerotic cardiovascular disease or hypercholesterolemia. The researchers then broke down appointment times from 8 AM to 4 PM into 1-hour blocks.

The results indicated that, while 36% of all visits to the primary care practices ended with clinicians prescribing statins, 38% of those prescriptions occurred in the morning and approximately 33% occurred in the afternoon.

Further, patients with visits between 8 AM and 9 AM were 12% less likely to be prescribed a statin, while patients with visits occurring at 12 PM were 37% less likely. After the 12 PM visits, patients were 27% less likely to be prescribed a statin for the rest of the day.

This relationship between statin prescription and standard of care depending on appointment time has been observed in other primary care modalities, such as flu shots or screening for breast or colorectal cancer.

“Our findings were concerning but unsurprising. Clinicians are faced with multiple cognitive demands that compete for their attention while providing care, especially later in the day,” the study authors concluded in an accompanying press release.² “Paired with an ever-growing list of evidence-backed treatment guidelines, our findings reveal that care quality can deteriorate as clinicians grapple with the cognitive fatigue and appointment lateness that is more likely to occur at the end of the day.”

—Leigh Precopio

Reference:

1. Hare AJ, Adusumalli S, Park S, Patel MS. Assessment of primary care appointment times and appropriate prescribing of statins for at-risk patients. JAMA Netw Open. Published online May 11, 2021. doi:10.1001/jamanetworkopen.2021.9050
2. Cholesterol-Lowering Statins Prescribed Less Later in Day. News release. Penn Medicine News. May 11, 2021. Accessed May 11, 2021. https://www.pennmedicine.org/news/news-releases/2021/may/cholesterol-lowering-statins-prescribed-less-later-in-day