Provider Adherence to Aspirin Prophylaxis Recommendations in Pregnancy at a Single Military Treatment Facility [ID: 1380223

Abstract

INTRODUCTION: Preeclampsia complicates 2–8% of pregnancies and is a major contributor to maternal and perinatal morbidity and mortality. Aspirin (ASA) is known to decrease rates of preeclampsia in patients at risk for developing the disease. We examined provider compliance with the U.S. Preventive Services Task Force risk-based aspirin prophylaxis guidelines at our institution and identified a need for improvement. METHODS: For quality improvement, we implemented provider education, updated patient history forms, and an embedded ASA checklist within our note template. We retrospectively reviewed demographics, medical/obstetric history, and candidacy/prescription placement for two patient groups at their first prenatal visit. The first was the preintervention group (January 1 to June 30, 2019; N=434) and the second was the postintervention group (July 1 to September 30, 2021; N=284). Preintervention and postintervention data were then compared to determine whether rates of compliance with ASA prophylaxis guidelines improved. RESULTS: A similar proportion of patients met criteria for ASA prophylaxis preintervention (43.1%, 95% CI 38.5–47.8%) and postintervention (46.8%, 95% CI 41.1–52.6%, P=.36), with similar proportions of patients who qualified with one high risk factor versus multiple moderate risk factors. There were significantly more patients who qualified for aspirin and were not identified in the preintervention group (67.9%, 95% CI 60.9–74.2%) than in the postintervention group (18.8%, 95% CI 13.0–26.3%, P<.0001). This improvement was even more pronounced in patients who only qualified by moderate risk factors (preintervention [79.7%, 95% CI 72.5–85.5%] versus postintervention [21.2%, 95% CI 14.7–29.7%]). CONCLUSION: The implementation of provider education, updated patient history forms, and an ASA checklist significantly improved provider adherence to ASA prophylaxis recommendations.