SPIDER: A Research & QI Collaboration Supporting Practices in Improving Care for Complex Elderly Patients

Summary

Elders living with multiple chronic conditions often take many drugs (polypharmacy); some of the drugs may not benefit them or may be harmful. The Canadian Institute for Health Information has reported that about one-quarter of Canadian seniors are prescribed ten or more different drugs each year. Polypharmacy can result in poorer health, reduced quality of life and high healthcare costs. Choosing Wisely Canada and the Canadian Deprescribing Network have suggested wiser uses for the following four Potentially Inappropriate Prescriptions (PIPs): drugs that reduce stomach acid; reduce anxiety and induce sleep; treat agitation; and treat type 2 diabetes but have a high risk of low blood sugar. To improve care for elderly patients living with polypharmacy, we propose SPIDER: a Structured Process Informed by Data, Evidence and Research. Using quality improvement (QI) and supported by Electronic Medical Record (EMR) data, SPIDER will invite family doctors, nurses, pharmacists and front desk staff to participate in Learning Collaboratives and learn from each other. The practice teams will work with a QI Coach to identify areas to improve, develop strategies and implement changes tailored to the local practice context. The objective of this study is to determine whether SPIDER will reduce PIPs for patients 65 years or older who are on ten or more different drugs. The study will also explore patient experience and provider satisfaction with SPIDER and assess the cost of running SPIDER. The study will first be tested for feasibility in Toronto, Edmonton and Montreal. Findings will then guide a Randomized Controlled Trial (RCT) in Calgary, Winnipeg, Ottawa, Montreal and Halifax where practices enrolled in the SPIDER intervention will be compared with those in usual care.

Conditions

• Polypharmacy
• Inappropriate Prescribing
• Aged
• Primary Health Care
• Quality Improvement
• Electronic Health Records

Interventions

PROCEDURE

SPIDER

The SPIDER intervention will include a family physician-led inter-professional practice team participating in 3-4 Learning Collaboratives over a period of 12 months, reviewing validated and comparable practice EMR data and working with a QI Coach to develop strategies and implement changes to improve care for elderly patients living with complex care needs and taking ten or more unique medications.

PROCEDURE

Usual Care

Physicians and their teams enrolled in this arm will follow the best scientific evidence available to provide standard care that is in the best interest of their patients.

Sponsors & Collaborators

• Canadian Institutes of Health Research (CIHR)

  collaborator OTHER_GOV

• University of Toronto

  collaborator OTHER

• North York General Hospital

  collaborator OTHER

• College of Family Physicians of Canada

  collaborator OTHER

• University of Ottawa

  collaborator OTHER

• University of Alberta

  collaborator OTHER

• University of Calgary

  collaborator OTHER

• University of Manitoba

  collaborator OTHER

• Research Manitoba

  collaborator OTHER

• Fonds de la Recherche en Santé du Québec

  collaborator OTHER_GOV

• Université de Montréal

  collaborator OTHER

• Nova Scotia Health Authority

  collaborator OTHER

• Dalhousie University

  collaborator OTHER

• Dalhousie Medical Research Foundation

  collaborator UNKNOWN

• Doctors Nova Scotia

  collaborator UNKNOWN

• Memorial University of Newfoundland

  collaborator OTHER

• University of British Columbia

  collaborator OTHER

• University of Toronto Practice Based Research Network

  lead OTHER

Principal Investigators

• Michelle Greiver, MD · North York General Hospital

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2018-03-26

Primary Completion

2027-03-31

Completion

2027-03-31

Countries

• Canada

Study Locations