Statin-prescribing for eligible adult HIV patients in an outpatient specialty clinic: a best practice implementation project

INTRODUCTION: HIV is a retrovirus affecting the body's immune system. People living with HIV (PWH) aged ≥ 45 have a higher risk of atherosclerotic cardiovascular disease (ASCVD). Statins are generally recommended for PWH with a 10-year ASCVD risk of ≥ 5%. OBJECTIVE: This project aimed to promote evidence-based practices (EBPs) regarding statin-prescribing for eligible PWH in an outpatient specialty clinic. METHODS: Guided by the JBI Evidence Implementation Framework, two EBPs for increasing statin-prescribing were used as audit criteria: (1) use of a validated tool to estimate ASCVD risk and (2) presence of an alert for clinicians in the electronic health record (EHR) for positive screenings. To determine compliance with EBPs, a baseline audit was completed via EHR reviews. Then, barriers to compliance were identified and strategies to improve compliance were implemented. A follow-up audit was conducted to measure changes in compliance with best practices. RESULTS: The baseline audit revealed 56% and 0% compliance with the two EBPs, respectively. Barriers to compliance included the absence of a standardized process for estimating patients' CVD risk and clinicians often being unaware of patients' statin eligibility. Strategies to improve EBP compliance included using a "Smart Phrase" to automatically insert a calculation of the 10-year ASCVD risk score into the EHR and placing a statin eligibility notification into eligible patients' EHRs. The follow-up audit indicated a decrease in compliance for Criterion 1 (56% to 52%) but an increase of 100% for Criterion 2. CONCLUSIONS: The project objective was partially met, but interventions were impractical for sustainability. Prescribing practices among nurse practitioners and medical doctors should be explored, as differences in prescribing habits were noticeable. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A516.