Quality improvement in ASA prescription in primary health care

Abstract

BACKGROUND. Potentially inappropriate prescribing (PIP) in above 65 years old community-dwelling population is common and may result in adverse drug effects, hospitalisations and increased morbidity. Interventions using explicit or implicit criteria, which are time-consuming and complex, so as to tackle PIP have not been proven useful. Unjustified acetylsalicylic acid (ASA) prescription in our setting is relatively common and no strategy has been implemented to deal with it. Plus, there is no data whether this wrong indication is due to a real inadequate prescription or a clinical registry deficiency.

OBJECTIVES. To assess the effectiveness of a short, defined and groupal educational intervention on unjustified ASA prescription in above 65 years old population in a primary health care setting, by measuring the percentage of ASA inappropriateness before and after the intervention in this segment of population. Secondary objectives are to analyse whether the potential decrease in ASA inadequacy prescription after the intervention is due to the fact that ASA had not been well-prescribed and it is a PIP or it is owing to the fact it has not been correctly registered in clinical record. We also aim to figure out which is the covariate that influences the most in reducing unjustified ASA prescription.

METHODS. A community intervention trial will be performed in 26 primary health teams (PHT) across Girona health region, in which 15 of them will receive an educational intervention on unjustified ASA and the resting PHT will not, being control groups. PHT clusters will be randomised according to their type (rural or urban) and within each of these blocks, according to their average income tercile. The feasibility of the educational intervention will be tested before executing the trial, by performing a pilot intervention. Intervention and control groups will be also compared to a national contemporaneous control group