{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:29:02Z","timestamp":1792114142591,"version":"4.4.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000050","name":"national heart, lung, and blood institute","doi-asserted-by":"publisher","award":["R56HL164379"],"award-info":[{"award-number":["R56HL164379"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Statin Choice is a shared decision-making encounter tool embedded in the electronic health record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the association between the use of Statin Choice, statin prescriptions by clinicians, prescription fills (primary adherence), and statin adherence at 12\u2009mo (secondary adherence).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cohort study at the Cleveland Clinic Health System.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects<\/jats:title>\n                    <jats:p>Statin-na\u00efve adults aged 40 to 75\u2009y with a 10-y atherosclerotic cardiovascular disease (ASCVD) risk of \u22655% and a primary care appointment between January 2020 and July 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Measures<\/jats:title>\n                    <jats:p>The primary exposure was the use of Statin Choice during a clinical encounter. We measured whether the use of Statin Choice was associated with statin prescriptions. We measured statin adherence based on pharmacy fill data at 60\u2009d (primary adherence) and 12\u2009mo (secondary adherence). We used mixed-effects logistic regression to estimate the adjusted odds of statin prescriptions and adherence at the 3 time points by the use of Statin Choice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Among 17,001 statin-na\u00efve patients, 13% viewed Statin Choice and 7% were prescribed a statin. The median ASCVD risk was 10%. Patients who were shown Statin Choice had 9.04 higher odds of being prescribed a statin compared with patients not shown Statin Choice (95% confidence interval [CI]: 7.86\u201310.4). Among patients prescribed a statin, the use of Statin Choice was associated with 5.75 higher odds of primary adherence compared with usual care (95% CI: 4.22\u20137.83). At 12\u2009mo, Statin Choice use was significantly associated with adherence in the unadjusted analysis (OR: 1.58; 95% CI: 1.05\u20132.08) but was not significant after adjustment for patient factors. Patients shown Statin Choice had an average of 12 mg\/dL reduction in low-density lipoprotein cholesterol at 12\u2009mo (95% CI: \u221216 mg\/dL, \u221210) compared with those not shown Statin Choice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this observational study, Statin Choice use was strongly associated with statin prescription and fills and weakly associated with adherence to statins for up to 1 y. A randomized trial is needed to confirm causality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Statin Choice is an electronic health record\u2013embedded shared decision-making encounter tool available for free in many health care systems.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Small randomized controlled trials have found modest associations between the use of Statin Choice and statin adherence using patient-reported data.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>In our large study using pharmacy fill data, clinician use of Statin Choice during a medical encounter was associated with significantly greater patient adherence with statins up to 1 y later.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Exposure to Statin Choice was associated with a significant reduction in low-density lipoprotein cholesterol over 1 y.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1177\/0272989x251346508","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T11:25:22Z","timestamp":1750764322000},"page":"884-891","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between Exposure to Statin Choice and Adherence to Statins: An Observational Cohort Study"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9177-480X","authenticated-orcid":false,"given":"Kathryn A.","family":"Martinez","sequence":"first","affiliation":[{"name":"Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0595-2898","authenticated-orcid":false,"given":"Victor M.","family":"Montori","sequence":"additional","affiliation":[{"name":"Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, the Cardiovascular Institute, and the Center for Digital Health, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-1313","authenticated-orcid":false,"given":"Larisa G.","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"Cleveland Clinic, Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA"},{"name":"Cleveland Clinic, Heart, Vascular &amp; Thoracic Institute, Department of Cardiovascular Medicine, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Kovach","sequence":"additional","affiliation":[{"name":"Cleveland Clinic, Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Boyer","sequence":"additional","affiliation":[{"name":"Cleveland Clinic, Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather McKee","family":"Hurwitz","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Center for Value-Based Care Research, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.010376"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2018.4936"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011765"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.13797"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1120"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0191817"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12991-020-00293-4"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.7224\/1537-2073.2017-070"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.023048"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2009.10.008"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.167.10.1076"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2015.08.032"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4055-8"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.009"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31829b1d2a"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2402-8"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2016.07.006"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2018-008022"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.1615"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-023-08597-3"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2022.101994"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-021-00145-6"}],"container-title":["Medical Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X251346508","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0272989X251346508","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X251346508","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:03:28Z","timestamp":1777658608000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0272989X251346508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":22,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/0272989X251346508"],"URL":"https:\/\/doi.org\/10.1177\/0272989x251346508","relation":{},"ISSN":["0272-989X","1552-681X"],"issn-type":[{"value":"0272-989X","type":"print"},{"value":"1552-681X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]}}}