Shelby Koen, Matthew Cavaletto, Lindsay Garris, Jennie Hewitt
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引用次数: 0
Abstract
Background: Aspirin is a commonly prescribed antiplatelet agent for primary and secondary prevention of cardiovascular events. Guidelines recommend avoiding aspirin for primary prevention in most patients aged ≥ 70 years, but there is limited data on the most effective way to deprescribe aspirin in outpatient settings.
Methods: This prospective quality improvement study used the US Department of Veterans Affairs (VA) VIONE medication safety dashboard to identify eligible patients at a Durham VA Health Care System (DVAHCS) community-based outpatient clinic. Patients were aged ≥ 70 years without known atherosclerotic cardiovascular disease and an active aspirin prescription as of September 1, 2022. Two pharmacists gave a deprescribing presentation to primary care practitioners (PCPs) 90 days later. The primary objective was to compare the efficiency of pharmacist direct deprescribing of aspirin with PCP deprescribing for primary prevention over a 12-week period following the education session. Secondary objectives assessed the number of aspirin orders discontinued, the effect of the education on aspirin deprescribing for primary prevention, and pharmacist time to complete the intervention.
Results: Two aspirin orders were deprescribed per hour of pharmacist time compared with 67 aspirin orders per hour for PCPs. In the 12 weeks following the PCP education session, 230 aspirin orders were discontinued, 97 by pharmacists and 133 by PCPs. Among the 868 patients identified, 224 met inclusion criteria for the pharmacist direct deprescribing intervention, and all patients were eligible through the PCP education method. Pharmacists spent about 48 hours on the pharmacist intervention and 1 hour on the PCP education intervention.
Conclusions: PCP education was more efficient for deprescribing aspirin compared with direct deprescribing by pharmacists based on the number of aspirin orders discontinued by time spent.