Pharmacist-Led Deprescribing of Aspirin for Primary Prevention of Cardiovascular Disease Among Geriatric Veterans.

Shelby Koen, Matthew Cavaletto, Lindsay Garris, Jennie Hewitt
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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.

药师主导的阿司匹林在老年退伍军人心血管疾病一级预防中的应用
背景:阿司匹林是一种常用的抗血小板药物,用于心血管事件的一级和二级预防。指南建议大多数年龄≥70岁的患者避免使用阿司匹林进行一级预防,但关于门诊解除阿司匹林处方的最有效方法的数据有限。方法:这项前瞻性质量改进研究使用美国退伍军人事务部(VA) VIONE用药安全仪表板来识别达勒姆VA医疗保健系统(DVAHCS)社区门诊诊所的合格患者。截至2022年9月1日,患者年龄≥70岁,无已知动脉粥样硬化性心血管疾病和有效阿司匹林处方。90天后,两名药剂师给初级保健医生(pcp)开处方。主要目的是比较在教育课程结束后的12周内,药剂师直接开阿司匹林处方与开PCP处方进行初级预防的效率。次要目标评估停用阿司匹林的数量、教育对一级预防阿司匹林处方的影响以及药剂师完成干预的时间。结果:药剂师每小时开2个阿司匹林处方,而pcp每小时开67个阿司匹林处方。在PCP教育课程结束后的12周内,230份阿司匹林订单被终止,97份由药剂师终止,133份由PCP终止。在868例患者中,224例患者符合药师直接处方干预的纳入标准,所有患者均通过PCP教育方法入选。药师干预时间约48小时,PCP教育干预时间约1小时。结论:基于停药次数和停药时间,PCP教育比药师直接开处方更有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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