Rothbauer Katherine, Siodlak Magdalena, Dreischmeier Emma, Ranola Trisha Seys, Welch Lauren
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
University of Wisconsin, Madison School of Pharmacy.
Fed Pract. 2022 Nov;39(Suppl 5):S37-S41a. doi: 10.12788/fp.0294. Epub 2022 Oct 14.
Recent guidelines indicate that aspirin affords less cardiovascular protection and greater bleeding risks in adults aged > 70 years. Deprescribing potentially inappropriate medications is particularly important in older adults, as this population experiences a high risk of adverse effects and polypharmacy. Limited data are available regarding targeted aspirin deprescribing approaches by pharmacists. The objective of this study was to implement and evaluate the success and feasibility of a pharmacist-led aspirin deprescribing protocol for older adults in a primary care setting.
This prospective feasibility study in a US Department of Veterans Affairs ambulatory care pharmacy setting included patients aged ≥ 70 years with documented aspirin use. We reviewed 459 patient records and determined that 110 were eligible for deprescribing. A pharmacistinitiated telephone call was attempted for each eligible patient to discuss the risks and benefits of deprescribing aspirin. The primary outcome was the proportion of patients reached for whom aspirin was discontinued. Secondary outcomes included patient rationale for declining deprescribing and the time to complete the intervention. Of 94 patients reached, 45 (48%) agreed to aspirin deprescribing, 3 (3%) agreed to dose reduction, and 29 (31%) declined the intervention. An additional 17 (18%) had previously stopped aspirin, which led to a medication reconciliation intervention. Pharmacists spent about 2 minutes per record review and 12 minutes on each encounter, including documentation.
Implementing a pharmacist-driven aspirin deprescribing protocol in a primary care setting led to the discontinuation of inappropriate aspirin prescribing in nearly half of older adults contacted. The protocol was well accepted by collaborating physicians and feasible for pharmacists to implement, with potential for further dissemination across primary care settings.
近期指南指出，阿司匹林在70岁以上成年人中提供的心血管保护作用较小，且出血风险更高。停用潜在不适当的药物对老年人尤为重要，因为该人群不良反应和多重用药风险较高。关于药剂师有针对性地停用阿司匹林的方法，现有数据有限。本研究的目的是在初级保健环境中实施并评估由药剂师主导的针对老年人的阿司匹林停用方案的成功率和可行性。
这项在美国退伍军人事务部门诊药房环境中进行的前瞻性可行性研究纳入了记录在案使用阿司匹林的70岁及以上患者。我们审查了459份患者记录，确定110名患者符合停用条件。对每名符合条件的患者尝试进行药剂师发起的电话沟通，以讨论停用阿司匹林的风险和益处。主要结局是成功联系到且停用阿司匹林的患者比例。次要结局包括患者拒绝停用的理由以及完成干预的时间。在成功联系到的94名患者中，45名（48%）同意停用阿司匹林，3名（3%）同意减少剂量，29名（31%）拒绝干预。另外17名（18%）此前已停用阿司匹林，这导致了药物重整干预。药剂师每份记录审查约花费2分钟，每次沟通包括记录在内花费12分钟。
在初级保健环境中实施由药剂师推动的阿司匹林停用方案致使近一半被联系的老年人停用了不适当的阿司匹林处方。该方案得到了合作医生的认可，药剂师实施起来可行，有在初级保健环境中进一步推广的潜力。
