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Identifying and reducing inappropriate aspirin use in primary care.
Christa Brooker1, Rebekah Compton1, Terri Babineau1
1Department of Family Medicine, University of Virginia, Charlottesville, Virginia, USA.
BMJ Open Quality
|November 6, 2023
Summary
A quality improvement intervention identified older adults taking aspirin for primary prevention. Education and provider review led to aspirin de-prescribing in 29% of patients, improving medication safety.
Area of Science:
- Geriatric Medicine
- Cardiovascular Disease Prevention
- Pharmacology
Background:
- Recent evidence questions aspirin's safety for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in older adults.
- Identifying and managing inappropriate aspirin use in this demographic is crucial.
Purpose of the Study:
- To develop a systematic approach for identifying patients aged 70+ on aspirin for primary prevention.
- To educate patients and providers on updated aspirin safety guidelines.
- To evaluate the impact of this intervention on aspirin de-prescribing.
Main Methods:
- Quality improvement intervention in two family medicine practices.
- Electronic medical record-based chart review to determine aspirin indication.
- Shared decision-making and patient/provider education.
- Longitudinal follow-up to assess de-prescribing rates.
Main Results:
- 145 of 361 (40%) patients aged 70+ were taking aspirin for primary ASCVD prevention.
- Aspirin was de-prescribed in 42 (29%) patients after 9 months.
- Patients seen by providers had significantly lower odds of remaining on aspirin (OR=0.87).
Conclusions:
- This study presents a novel, EMR-based method to identify and reduce inappropriate aspirin use in older adults.
- The intervention successfully facilitated aspirin de-prescribing, enhancing medication safety.
- This approach can be scaled to larger populations to optimize primary prevention strategies.
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