Koen Shelby, Cavaletto Matthew, Garris Lindsay, Hewitt Jennie
Durham Veterans Affairs Health Care System, North Carolina.
Veterans Affairs Northern Indiana Health Care System, Fort Wayne, Indiana.
Fed Pract. 2025 Jan;42(1):22-28. doi: 10.12788/fp.0537. Epub 2025 Jan 16.
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.
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.
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.
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.
阿司匹林是一种常用于心血管事件一级和二级预防的抗血小板药物。指南建议，大多数70岁及以上的患者应避免使用阿司匹林进行一级预防，但在门诊环境中停用阿司匹林的最有效方法的数据有限。
这项前瞻性质量改进研究使用美国退伍军人事务部（VA）的VIONE药物安全仪表板，在达勒姆VA医疗保健系统（DVAHCS）的社区门诊诊所识别符合条件的患者。患者年龄≥70岁，截至2022年9月1日无已知的动脉粥样硬化性心血管疾病且有阿司匹林的有效处方。90天后，两名药剂师向初级保健医生（PCP）进行了关于停用药物的介绍。主要目标是比较药剂师直接停用阿司匹林与PCP在教育课程后的12周内进行一级预防停用阿司匹林的效率。次要目标评估了停用的阿司匹林处方数量、教育对一级预防停用阿司匹林的影响以及药剂师完成干预的时间。
药剂师每工作一小时可停用两份阿司匹林处方，而PCP每小时可停用67份阿司匹林处方。在PCP教育课程后的12周内，230份阿司匹林处方被停用，其中药剂师停用97份，PCP停用133份。在确定的868名患者中，224名符合药剂师直接停用药物干预的纳入标准，所有患者通过PCP教育方法均符合条件。药剂师在药剂师干预上花费约48小时，在PCP教育干预上花费1小时。
根据按时间计算停用的阿司匹林处方数量，与药剂师直接停用相比，PCP教育在停用阿司匹林方面更有效。
