1030 Inferring physicians’ decisional cues for low-dose aspirin eligibility using a prenatal care app

Abstract

Randomized controlled trials show that taking low-dose aspirin (LDASA) during pregnancy is effective at modifying pre-eclampsia risk. We use data collected through a prenatal care app prescribed to all pregnant patients in a large academic healthcare system to identify those who are eligible for low-dose aspirin and examine which risk factors providers appear to rely on in making a LDASA recommendation. The MyHealthyPregnancyTM (MHP) app was routinely prescribed to pregnant patients at their first prenatal appointment. A secondary analysis of a prospective observational study examined rates of patients meeting US Preventive Services Task Force (USPSTF) risk criteria for taking LDASA through questions administered as part of an app onboarding process. MHP also prompted users with the following monthly question, “Since you've been pregnant, has your provider recommended that you take aspirin?” From November 2019 - Sept, 2020, the MHP app onboarded 2,910 users. Of the 1724 that voluntarily reported USPSTF risk criteria through the app, 17% (295) had at least one high risk factor. Of the 2,056 that reported moderate risk factors, 52% (1,067) had two or more moderate risk factors. Of the 1439 that reported whether they received LDASA recommendation, 13% (184) indicated that their physician recommended LDASA, 85% reported not receiving a recommendation, and 2% expressed uncertainty. Only 41% (53/130) of those who completed the recommendation question and met the USPSTF high risk criteria and 15% (80/530) who met moderate risk criteria were correctly recommended LDASA. Table 1 illustrates the risk criteria associated with patients receiving LDASA recommendation. Using a prenatal app for tracking, the majority of users meeting high and moderate risk criteria reported not receiving LDASA recommendation from their provider, despite evidence-based guidelines for pre-eclampsia prevention. Providers may rely on some cues for LDASA eligibility at the cost of others. Findings suggest opportunities for prenatal app-based identification of those at-risk, as well as intervention.