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The article reviews several studies on medical quality including "Improving Medication Reconciliation in the Outpatient Setting," by Prathiba Varkey et al, "Implementation of a Medication Reconciliation in an Ambulatory Internal Medicine Clinic," by Claudia L. Nassaralla, James M. Naessens et al, and "How Do Teams in Quality Improvement Collaboratives Interact," by Jill A. Marsteller, Stephen M. Shortell et al.

Introduction: The 2013 American College of Cardiology/American Heart Association Cholesterol Treatment Guideline increased the number of primary prevention patients eligible for statin therapy, yet uptake of these guidelines has been modest. Hypothesis: We hypothesized that primary care providers' (PCPs) reported beliefs and approaches to discussing statins for primary prevention vary and are associated with statin prescription. Methods: We surveyed 164 PCPs from a community-based practice network in North Carolina in 2017. Reported beliefs and approaches were examined, along with statin prescription rates during 2014-2015 in primary prevention patients with no prior statin prescription. Results: Seventy-two PCPs (43.9%) completed the survey. The median estimate of the relative risk reduction for high-intensity statins was 45% (IQR 25%-50%). A minority of providers (27.8%) believed statins caused diabetes, and only 16.7% reported always/very often discussing it with their patients. Most (97.2%) PCPs believed that statins cause myopathy and 72.3% reported always/very often discussing this with patients. Most (77.7%) reported always/very often using the 10-year ASCVD risk calculator to guide decisions, 59.8% reported that in the majority of cases prescriptions were influenced by other clinical risk factors and 43.1% that patient preferences altered prescribing. Of 6,172 eligible patients of survey respondents, 22.3% received a prescription for a moderate- or high-intensity statin. After adjustment for patient/provider characteristics, only lower reliance on risk factors beyond estimated ASCVD risk was associated with a modest increased likelihood of statin prescription (odds ratio 1.12, 95% confidence interval 1.03-1.23). Conclusions: Although beliefs and approaches to statin discussions vary among community PCPs, prescription rates are low and minimally associated with those beliefs. These results highlight the complexity of increasing statin prescriptions for primary prevention and suggest that efforts are needed beyond influencing PCPs' beliefs and motivation, particularly given the frequency with which reported patient preferences conflict with PCP recommendations. [ABSTRACT FROM AUTHOR]