Ellison Parker L, Holman Nathan, Wallace Kristin, Cote Gregory A, Elmunzer B Joseph, Brock Andrew S
Department of Internal Medicine and the Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States.
Endosc Int Open. 2020 Jun;8(6):E708-E716. doi: 10.1055/a-1134-4813. Epub 2020 May 25.
Existing guidelines recommend continuation of aspirin therapy prior to outpatient endoscopic procedures, as it reduces peri-procedural cardiovascular events and is not associated with an increased risk of bleeding. Despite this, many patients at our institution inappropriately alter their aspirin prior to endoscopy. We sought to identify why this occurs and implement an intervention that could reduce improper aspirin alteration. All adult patients undergoing outpatient endoscopy at the Medical University of South Carolina were administered a survey querying demographics, aspirin use, endoscopic procedure, thromboembolic risk factors, and pre-procedural aspirin alteration, if any. An intervention involving revised written and verbal instructions as well as an automated voicemail aimed at ensuring patients adhere to guidelines was then undertaken. The same survey was administered after the intervention to assess for improved adherence. A total of 240 patients from the initial survey reported daily aspirin use, of which 114 (47.5 %) inappropriately altered aspirin therapy. A total of 182 patients from the post-intervention survey reported daily aspirin use, of which 66 (36.3 %) inappropriately altered aspirin therapy. This was a statistically significant reduction ( = 0.04), which included adjustments for age, sex, procedure type, and thromboembolic risk. A high proportion of patients at our institution inappropriately alter aspirin therapy prior to outpatient endoscopy. The reasons for this behavior include patient self-direction, misguidance from staff, and instruction from other physicians. This alteration can be reduced significantly through an intervention that educates both patients and staff on continuation of aspirin therapy prior to outpatient endoscopy.
现有指南建议在门诊内镜检查前继续使用阿司匹林治疗，因为这可降低围手术期心血管事件的发生风险，且与出血风险增加无关。尽管如此，我们机构的许多患者在内镜检查前仍不恰当地调整了阿司匹林的服用。我们试图找出出现这种情况的原因，并实施一项能够减少阿司匹林服用不当调整的干预措施。对所有在南卡罗来纳医科大学接受门诊内镜检查的成年患者进行了一项调查，询问其人口统计学信息、阿司匹林使用情况、内镜检查程序、血栓栓塞危险因素以及术前是否调整了阿司匹林服用（若有）。随后开展了一项干预措施，包括修订书面和口头说明以及设置自动语音邮件，旨在确保患者遵循指南。干预措施实施后进行了同样的调查，以评估依从性是否有所改善。在初始调查中，共有240名患者报告每日服用阿司匹林，其中114名（47.5%）不恰当地调整了阿司匹林治疗。在干预措施实施后的调查中，共有182名患者报告每日服用阿司匹林，其中66名（36.3%）不恰当地调整了阿司匹林治疗。这是一个具有统计学意义的下降（P = 0.04），其中包括对年龄、性别、检查程序类型和血栓栓塞风险的调整。我们机构中很大一部分患者在门诊内镜检查前不恰当地调整了阿司匹林治疗。这种行为的原因包括患者自行决定、工作人员的错误指导以及其他医生的指示。通过一项对患者和工作人员进行门诊内镜检查前继续使用阿司匹林治疗教育的干预措施，这种调整可以显著减少。
