Key result
Clinical uncertainty, patient resistance, and consultation time constraints drive GP non-prescribing of aspirin after stroke.
Why the study?
Aspirin prescribing for secondary prevention of stroke is sub-optimal, and little is known about why GPs do not prescribe aspirin to eligible patients.
Why do general practitioners not prescribe aspirin for secondary prevention of stroke to eligible patients?
Why do general practitioners not prescribe aspirin for secondary prevention of stroke to eligible patients?
Sub-optimal aspirin prescribing for secondary stroke prevention in primary care is driven by difficulties applying guidelines, patient resistance, and time constraints, highlighting the need for better decision support tools.
Answers are grounded in this paper and cite their sources.
Barriers to appropriate aspirin prescribing in primary care warrant targeted exploration; leaves open whether addressing them improves secondary stroke prevention rates.
BACKGROUND: Despite evidence-based guidelines, aspirin prescribing for the secondary prevention of stroke is sub-optimal. Little is known about why general practitioners do not prescribe aspirin to indicated patients. We sought to identify and describe factors that lead general practitioners (GPs) not to prescribe aspirin to eligible stroke patients. This was the first stage of a study exploring the need for and means of improving levels of appropriate aspirin prescribing. METHOD: Qualitative interviews with 15 GPs in the West Midlands. RESULTS: Initially, many GPs did not regard their prescribing as difficult or sub-optimal. However on reflection, they gave several reasons that lead to them not prescribing aspirin for eligible patients or being uncertain. These include: difficulties in applying generic guidelines to individuals presenting in consultations, patient resistance to taking aspirin, the prioritisation of other issues in a time constrained consultation and problems in reviewing the medication of existing stroke patients. CONCLUSION: In order to improve levels of appropriate aspirin prescribing, the nature and presentation risk information available to GPs and patients must be improved. GPs need support in assessing the risks and benefits of prescribing for patients with combinations of complicating risk factors, while means of facilitating improved GP-patient dialogue are required to help address patient uncertainty. A decision analysis based support system is one option. Decision analysis could synthesise current evidence and identify risk data for a range of patient profiles commonly presenting in primary care. These data could then be incorporated into a user-friendly computerised decision support system to help facilitate improved GP-patient communication. Measures of optimum prescribing based upon aggregated prescribing data must be interpreted with caution. It is not possible to assess whether low levels of prescribing reflect appropriate or inappropriate use of aspirin in specific patients where concordance between the GP and the patient is practised.
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Short et al. (2003) studied Secondary prevention of stroke (n=15). Aspirin prescribing decisions was evaluated on Reasons for not prescribing aspirin to eligible stroke patients. General practitioners reported that clinical uncertainty, patient resistance, and time constraints in consultations are the primary reasons they do not prescribe aspirin to eligible stroke patients.
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