期刊
IMPLEMENTATION SCIENCE
卷 14, 期 -, 页码 -出版社
BMC
DOI: 10.1186/s13012-019-0904-4
关键词
Polypharmacy; Inappropriate prescribing; Aged; Primary health care; Quality improvement; Electronic health records; Social facilitation; Clinical trials; randomized
资金
- Canadian Institutes of Health Research (CIHR)
- Quality and Innovation Program, the Department of Family and Community Medicine, University of Toronto
- University of Toronto Practice Based Research Network
- North York General Hospital
- College of Family Physicians of Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta
- Department of Family Medicine, Faculty of Medicine, University of Calgary
- Manitoba Primary Care Research Network, the Department of Family Medicine, University of Manitoba
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba
- Research Manitoba
- Fonds de recherche du Quebec -Sante
- Reseau-1 Quebec, University of Montreal
- Nova Scotia Health Authority
- Department of Family Medicine, Dalhousie University
- Department of Community Health & Epidemiology, Dalhousie University
- Undergraduate Medical Education, Faculty of Medicine, Dalhousie University
- Dalhousie Medical Research Foundation
- Doctors Nova Scotia
- Gordon F. Cheesbrough Research Chair at North York General Hospital
- Public Health Agency of Canada
- Vice President Research Office, Dalhousie University
- Department of Family and Community Medicine, University of Toronto
BackgroundElders living with polypharmacy may be taking medications that do not benefit them. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high care costs, and persistently complex care needs. While many medications could be problematic, this project targets medications that should be deprescribed for most elders and for which guidelines and evidence-based deprescribing tools are available. These are termed potentially inappropriate prescriptions (PIPs) and are as follows: proton pump inhibitors, benzodiazepines, antipsychotics, and sulfonylureas. Implementation strategies for deprescribing PIPs in complex older patient populations are needed.MethodsThis will be a pragmatic cluster randomized controlled trial in community-based primary care practices across Canada. Eligible practices provide comprehensive primary care and have at least one physician that consents to participate. Community-dwelling patients aged 65years and older with ten or more unique medication prescriptions in the past year will be included. The objective is to assess whether the intervention reduces targeted PIPs for these patients compared with usual care. The intervention, Structured Process Informed by Data, Evidence and Research (SPIDER), is a collaboration between quality improvement (QI) and research programs. Primary care teams will form interprofessional Learning Collaboratives and work with QI coaches to review electronic medical record data provided by their regional Practice Based Research Networks (PBRNs), identify areas of improvement, and develop and implement changes. The study will be tested for feasibility in three PBRNs (Toronto, Montreal, and Edmonton) using prospective single-arm mixed methods. Findings will then guide a pragmatic cluster randomized controlled trial in five PBRNs (Calgary, Winnipeg, Ottawa, Montreal, and Halifax). Seven practices per PBRN will be recruited for each arm. The analysis will be by intention to treat. Ten percent of patients who have at least one PIP at baseline will be randomly selected to participate in the assessment of patient experience and self-reported outcomes. Qualitative methods will be used to explore patient and physician experience and evaluate SPIDER's processes.ConclusionWe are testing SPIDER in a primary care population with complex care needs. This could provide a widely applicable model for care improvement.Trial registrationClinicaltrials.gov NCT03689049; registered September 28, 2018
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