M. Welton et al., General practitioners' use of aspirin in the secondary prevention of vascular events: knowledge, attitudes, and current practice, BR J GEN PR, 49(445), 1999, pp. 607-610
Background. Aspirin has been shown to significantly reduce mortality when t
aken by patients with vascular disease. Studies in secondary care have show
n its use to be suboptimal, but aspirin use among general practitioners (GP
s) has not been directly assessed, although some data on aspirin use in the
community exists. Little is known about factors that might influence aspir
in use by GPs, despite much recent research on the wider issues of followin
g evidence-based 'best' practice.
Aims. To determine the use of aspirin by GPs in preventing vascular events,
and to identify factors influencing its use.
Method. Postal questionnaire using clinical vignettes sent to all GPs ident
ified from the North Staffordshire Health Authority database.
Results. Of 230 questionnaires sent, 123 were returned giving an overall re
sponse of 54%. For patients with vascular disease, a median of 86% of GPs a
dvised aspirin use, with a range from 80% to 96% according to the site oft
he vascular disease. Responses were analysed when an additional diagnosis w
as added to the clinical situation. These diagnoses were designed to repres
ent conditions in which aspirin may be used, but with caution. For patients
falling into this category, the benefits of aspirin prophylaxis usually ou
tweigh the risks of aspirin use. The addition of such a diagnosis was assoc
iated with a median reduction to 67% of responders who indicated that aspir
in would be used (range = 66% to 85%). A contraindication to aspirin reduce
d its use to 66% of the sample. In patients without vascular disease but wi
th multiple risk factors for future cardiovascular disease, the use of aspi
rin ranged from 17% to 54%. There was self-reported confusion among respond
ers about what dose and formulation of aspirin to advise and prescribe.
Conclusions. The results obtained from the responders may not represent the
opinion of all GPs in the North Staffordshire area owing to the low respon
se rate. There is, however, stated unwillingness to advise aspirin prophyla
xis by some GPs, even when it is clearly indicated. The presence of comorbi
dity reduces its use further, regardless of whether this involves a contrai
ndication to aspirin or not A substantial proportion of GPs are recommendin
g the use of aspirin in patients with risk factors for, but without actual
symptoms of, vascular disease. Further education is required to reduce unce
rtainty about which formulation and dose of aspirin to use. Recommendations
from authorities on the subject should be disseminated and must be practic
al and clear. Research into the failure to incorporate quality research int
o everyday practice must continue.