Deprescribing in older patients, a work-in-progress RCT: SPIDER
Author(s): Celine Jean-Xavier, Sumeet Kaila, Michelle Greiver, Alex Singer, Keri Harvey, Leanne Kosowan, Dewdunee Himasara Pathiraja, Simone Dahrouge, Donna Manca, Mathew Grandy, Stephanie Garies
Context: One quarter of Canadians over 65 years of age are prescribed ten or more different medications. Polypharmacy is associated with higher healthcare costs and reduced quality of life. The Structured Process Informed by Data, Evidence and Research (SPIDER) approach has been applied to deprescribing in primary care for patients over 65 years experiencing polypharmacy.
Study design: randomized controlled trial comparing the SPIDER approach to usual care.
Intervention: SPIDER includes participation in Quality improvement (QI) activities and learning collaboratives; support through a QI coach and validated EMR data reports for audit and feedback. The intervention lasts a year.
Main outcome measures: Proportion of potentially inappropriate prescriptions (PIPs) among eligible patients in SPIDER, using EMR data. Secondary outcome: proportion of patients not on PIPs.
Results: Preliminary data are available for 4,120 patients in the practices of 108 primary care providers that participate in 3 Practice Based Research Networks (PBRNs) as part of the Canadian Primary Care Sentinel Surveillance Network.
PIPs decreased by 12% in the control arm and 13.3% in the intervention arm. By the end of the trial, the proportion of patients not on PIPs increased by 9.5% in the control arm and 10.3% in the intervention arm.
Conclusion: We conducted a preliminary analysis in three Networks. There were reductions in PIPs in both groups, possibly reflecting secular trends or pandemic-related improvements in prescribing. QI tools and processes derived from this work can support future QI activities in primary care.