A simple nudge leads to more statin prescriptions and better health

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 keep their statins on hand. The researchers "nudged" doctors through a standard change in the electronic health record that made a 90-day supply of the drug the default option, rather than actively choosing a 30-day supply. The study from the Perelman School of Medicine at the University of Pennsylvania was published this month inJAMA INTERNAL MEDICINE.

For patients managing chronic illnesses, this simple change will only make life easier by eliminating eight pharmacy trips per medication and reducing the chances of being late or refilling. Over time, I hope this leads to 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 Medical Director of Population Health at the University of Pennsylvania Health System

Make the right choice the easy choice

Previous research showed that patients with hardened arteries who took their statins only about half 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 took statin medications regularly. The number was even smaller—38 percent among those with diabetes.

A nudge is a behavioral science approach to guiding people toward a desired outcome, but the key is to make that choice desirable and interference-free.

"Making the right choice. The simple choice is a core tenet of Nudge. What's exciting is that this small change, requiring no 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 associate professor of emergency medicine and epidemiology.

At the start of the study in 2022, approximately 71 percent of participating physicians at Penn Medicine prescribed 90-day supplies of statins. At the end of the study in 2024, 91 percent of participating physicians ordered 90-day prescriptions rather than actively choosing the other 30-day supply option.

Ultimately, the study resulted in 7,200 fewer 30-day prescriptions. And because of the success in the statin nudge, Penn Medicine's change in delays to longer prescriptions has expanded to include blood pressure and diabetes medications.

Consider access for all

In addition to the overall 20-point swing in longer prescriptions, researchers also saw closing demographic differences in prescription length.

Before the nudges, Hispanic and Black patients, as well as those who lived in ZIP codes where the median household income was below $50,000, were significantly less likely to receive 90-day statin prescriptions. For example, while more than 70 percent of doctors wrote 90-day prescriptions for non-Hispanic white patients, only about 67 percent of doctors for black patients also wrote 90-day prescriptions.

At the end of the study, 90 percent or more of all patients' doctors wrote statin prescriptions for 90-day supplies, regardless of how low the base rate was.

“What makes this intervention particularly powerful is how these differences were completely eliminated,” said co-author Alexander Fanaroff, MD, assistant professor of cardiovascular medicine. “The study concluded that approximately 90 percent of patients across all demographic groups received longer prescriptions, demonstrating how we can advance health equity without requiring additional resources.”

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