Implementation of an Aspirin Utilization Program in an Early Pregnancy Access Center

Objective Despite national guidelines, low-dose aspirin (LDA) for preeclampsia prevention is underutilized. Standardizing the screening process, increasing patient knowledge, and enhancing contact with the health care system may improve utilization rates. Our objective is to evaluate whether a multifaceted intervention increases the proportion of patients who initiate LDA at the recommended gestational age as compared with routine prenatal care. Study Design This observational cohort study included patients entering prenatal care within a large urban medical center in the Bronx, New York, United States. Patients initiating care through our Early Pregnancy Access Center (EPAC) and receiving the intervention, including standardized screening for preeclampsia risk factors, prescribing of aspirin with education during prenatal intake, and follow-up outreach, were compared with patients initiating routine prenatal care at other sites within the institution. The primary outcome was the proportion of eligible patients who initiated aspirin by 16 weeks' gestation. Secondary outcomes included the proportion of patients who continued to utilize aspirin at 24 weeks' gestation, development of hypertensive disorders of pregnancy (HDP), and pregnancy outcomes. Results A total of 366 patients (78.5%) in the EPAC cohort and 296 patients (81.1%) in the routine prenatal care cohort had qualifying risk factors for LDA. Patients in both groups were largely Black or Hispanic and had public insurance. EPAC patients were more likely to initiate aspirin by 16 weeks (70.7 vs. 38.6%, adjusted odds ratio [aOR]: 4.39, 95% confidence interval [CI]: 2.80-6.90) and more likely to continue to utilize aspirin at 24 weeks (74.7 vs. 43.8%, aOR: 4.43, 95% CI: 2.93-6.72). HDP were highly prevalent in both groups (37.8% in EPAC vs. 34.7% in routine prenatal care, p = 0.45). Conclusion A concerted and standardized effort to identify, educate, and support patients at risk for preeclampsia is associated with higher LDA utilization in a high-risk population. Obstetric providers can consider similar approaches to reduce the quality gap in rates of LDA use. Key Points Low-dose aspirin use can be improved. Early screening increases aspirin use. Outreach supports aspirin adherence.