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SPIDER: A Research & QI Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
Sponsor: University of Toronto Practice Based Research Network
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.
Official title: SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
Key Details
Gender
All
Age Range
65 Years - Any
Study Type
INTERVENTIONAL
Enrollment
104
Start Date
2018-03-26
Completion Date
2027-03-31
Last Updated
2025-03-25
Healthy Volunteers
No
Conditions
Interventions
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.
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.
Locations (9)
Southern Alberta Primary Care Research Network (SAPCReN)
Calgary, Alberta, Canada
Northern Alberta Primary Care Research Network (NAPCReN)
Edmonton, Alberta, Canada
British Columbia node of the pan-Canadian CPCSSN (BC-CPCSSN)
Vancouver, British Columbia, Canada
Manitoba Primary Care Research Network (MaPCReN)
Winnipeg, Manitoba, Canada
Atlantic Practice Based Research Network (APBRN)
St. John's, Newfoundland and Labrador, Canada
Maritime Family Practice Research Network (MaRNet-FP)
Halifax, Nova Scotia, Canada
Ottawa Practice Enhancement Network (OPEN )
Ottawa, Ontario, Canada
University of Toronto Practice Based Research Network
Toronto, Ontario, Canada
Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM)
Laval, Quebec, Canada