Improving aspirin prophylaxis in a primary care diabetic population

Study Objective. To evaluate and improve adherence to American Diabetes Association guidelines for prophylactic aspirin therapy in ambulatory patients with diabetes using a pharmacy-directed intervention. Design. Unblinded, single intervention. Setting. Rural, primary care clinic. Subjects. Eighty-five patients with a diagnosis of diabetes mellitus. Intervention. Patients with diabetes were identified from database searches and routine clinic visits. Medical records were screened for aspirin use, allergies, adverse events, and contraindications. During routine clinic visits or structured telephone interviews, patients with indications for aspirin therapy were advised to begin enteric-coated aspirin 81 mg/day. A follow-up survey assessed adherence. Measurements and Main Results. At baseline, 28 (33%) of 85 patients were receiving aspirin therapy. An additional 8 patients had contraindications to aspirin, and 2 patients had no indications for aspirin therapy. Aspirin was recommended to 27 patients during clinic interventions and to 15 patients during telephone interventions. Two patients declined the recommendation. At the completion of this intervention, 70 (82%) of 85 patients were receiving daily aspirin or had accepted the recommendation to begin therapy. Conclusions. A pharmacy-directed intervention increased prophylactic aspirin therapy in patients with diabetes from 33% of patients at baseline to 82% at the end of the study. The intervention, which has a simple, patient-focused design, serves as a template for improving aspirin prophylaxis among patients with diabetes in other ambulatory settings.