Identifying and reducing inappropriate aspirin use in primary care
Objective Recent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were to (1) develop a systematic approach to identifying patients aged 70 and older...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/4/e002457.full |
| _version_ | 1797366003375538176 |
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| author | Li Li Christa Brooker Rebekah Compton Terri Babineau Cornelius Afetorli Normeshie Sarah Rachel Blackstone |
| author_facet | Li Li Christa Brooker Rebekah Compton Terri Babineau Cornelius Afetorli Normeshie Sarah Rachel Blackstone |
| author_sort | Li Li |
| collection | DOAJ |
| description | Objective Recent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were to (1) develop a systematic approach to identifying patients aged 70 and older taking aspirin for primary prevention, (2) provide patient and provider education about updated literature and recommendations regarding aspirin safety and (3) evaluate the impact of this intervention on aspirin de-prescribing.Design This was a quality improvement intervention with prospective, longitudinal follow-up.Setting This study was conducted in two family medicine practices within an academic medical centre.Participants Patients aged 70 years and older with aspirin listed on the current medication list.Methods This is an electronic medical record-based chart review and educational intervention based on shared decision-making to reduce inappropriate aspirin use in primary practice. A chart review process was developed to identify the clinical indication for aspirin use. Patients taking aspirin for primary prevention were flagged for the primary care providers to review. Multilevel logistic regression models assessed factors affecting aspirin de-prescribing and longitudinal trend.Results Of 361 patients aged 70 years or older, 145 (40%) were taking aspirin for primary prevention of atherosclerotic cardiovascular disease. After 9 months, aspirin was deprescribed in 42 (29%) of these patients. Patients seen by their providers during the study period had lower odds of having aspirin on their medication list (OR=0.87, 95% CI: 0.81, 0.94) as compared with patients taking aspirin who were not seen by their healthcare provider.Conclusion This is the first study to develop and implement a method of identifying potentially inappropriate aspirin use based on recent clinical evidence highlighting the risk of aspirin use for primary prevention in older adults. Future initiatives can leverage existing electronic medical record platforms to efficiently identify patients and expand these efforts to larger patient populations. |
| first_indexed | 2024-03-08T16:57:59Z |
| format | Article |
| id | doaj.art-88e94ffe86d74f438ba4d311dae5e8de |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-03-08T16:57:59Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-88e94ffe86d74f438ba4d311dae5e8de2024-01-04T19:45:06ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-11-0112410.1136/bmjoq-2023-002457Identifying and reducing inappropriate aspirin use in primary careLi Li0Christa Brooker1Rebekah Compton2Terri Babineau3Cornelius Afetorli Normeshie4Sarah Rachel Blackstone515 Department of Intervention, Xijing Hospital of Air Force Military Medical University, Xi`an, ChinaDepartment of Family Medicine, University of Virginia, Charlottesville, Virginia, USADepartment of Family Medicine, University of Virginia, Charlottesville, Virginia, USADepartment of Family Medicine, University of Virginia, Charlottesville, Virginia, USADepartment of Family Medicine, University of Virginia, Charlottesville, Virginia, USAOffice of Planning, Analytics & Institutional Research, James Madison University, Harrisonburg, Virginia, USAObjective Recent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were to (1) develop a systematic approach to identifying patients aged 70 and older taking aspirin for primary prevention, (2) provide patient and provider education about updated literature and recommendations regarding aspirin safety and (3) evaluate the impact of this intervention on aspirin de-prescribing.Design This was a quality improvement intervention with prospective, longitudinal follow-up.Setting This study was conducted in two family medicine practices within an academic medical centre.Participants Patients aged 70 years and older with aspirin listed on the current medication list.Methods This is an electronic medical record-based chart review and educational intervention based on shared decision-making to reduce inappropriate aspirin use in primary practice. A chart review process was developed to identify the clinical indication for aspirin use. Patients taking aspirin for primary prevention were flagged for the primary care providers to review. Multilevel logistic regression models assessed factors affecting aspirin de-prescribing and longitudinal trend.Results Of 361 patients aged 70 years or older, 145 (40%) were taking aspirin for primary prevention of atherosclerotic cardiovascular disease. After 9 months, aspirin was deprescribed in 42 (29%) of these patients. Patients seen by their providers during the study period had lower odds of having aspirin on their medication list (OR=0.87, 95% CI: 0.81, 0.94) as compared with patients taking aspirin who were not seen by their healthcare provider.Conclusion This is the first study to develop and implement a method of identifying potentially inappropriate aspirin use based on recent clinical evidence highlighting the risk of aspirin use for primary prevention in older adults. Future initiatives can leverage existing electronic medical record platforms to efficiently identify patients and expand these efforts to larger patient populations.https://bmjopenquality.bmj.com/content/12/4/e002457.full |
| spellingShingle | Li Li Christa Brooker Rebekah Compton Terri Babineau Cornelius Afetorli Normeshie Sarah Rachel Blackstone Identifying and reducing inappropriate aspirin use in primary care BMJ Open Quality |
| title | Identifying and reducing inappropriate aspirin use in primary care |
| title_full | Identifying and reducing inappropriate aspirin use in primary care |
| title_fullStr | Identifying and reducing inappropriate aspirin use in primary care |
| title_full_unstemmed | Identifying and reducing inappropriate aspirin use in primary care |
| title_short | Identifying and reducing inappropriate aspirin use in primary care |
| title_sort | identifying and reducing inappropriate aspirin use in primary care |
| url | https://bmjopenquality.bmj.com/content/12/4/e002457.full |
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