Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot
Abstract Background Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorb...
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| Format: | Article |
| Language: | English |
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BMC
2017-08-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-017-0629-1 |
| _version_ | 1819135864873156608 |
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| author | Caroline McCarthy Barbara Clyne Derek Corrigan Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Carmel Hughes Paddy Gillespie Susan M. Smith |
| author_facet | Caroline McCarthy Barbara Clyne Derek Corrigan Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Carmel Hughes Paddy Gillespie Susan M. Smith |
| author_sort | Caroline McCarthy |
| collection | DOAJ |
| description | Abstract Background Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorbidity guideline that advises providing an individualised medication review for all people prescribed 15 or more repeat medicines. This study incorporates this guideline and aims to assess the effectiveness of a complex intervention designed to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care. Methods This study is a cluster randomised controlled trial, involving 30 general practices and 450 patients throughout Ireland. Practices will be eligible to participate if they have at least 300 patients aged 65 years and over on their patient panel and if they use either one of the two predominant practice management software systems in use in Ireland. Using a software patient finder tool, practices will identify and recruit patients aged 65 years and over, who are prescribed at least 15 repeat medicines. Once baseline data collection is complete, practices will be randomised using minimisation by an independent third party to either intervention or control. Given the nature of the intervention, it is not possible to blind participants or study personnel. GPs in intervention practices will receive login details to a website where they will access training videos and a template for conducting an individualised structured medication review, which they will undertake with each of their included patients. Control practices will deliver usual care over the 6-month study period. Primary outcome measures pertain to the individual patient level and are the proportion of patients with any PIP and the number of repeat medicines. Discussion Disease-specific approaches in multimorbidity may be inappropriate and result in fragmented and poorly co-ordinated care. This pragmatic study is evaluating a complex intervention that is relevant across multiple conditions and addresses potential concerns around medicines safety in this vulnerable group of patients. The potential for system-wide implementation will be explored with a parallel mixed methods process evaluation. Trial registration ISRCTN: 12752680 , Registered 20 October 2016. |
| first_indexed | 2024-12-22T10:25:52Z |
| format | Article |
| id | doaj.art-93a16e9d21be49678a6a579c5ecc14ab |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-22T10:25:52Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-93a16e9d21be49678a6a579c5ecc14ab2022-12-21T18:29:30ZengBMCImplementation Science1748-59082017-08-0112111310.1186/s13012-017-0629-1Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilotCaroline McCarthy0Barbara Clyne1Derek Corrigan2Fiona Boland3Emma Wallace4Frank Moriarty5Tom Fahey6Carmel Hughes7Paddy Gillespie8Susan M. Smith9HRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandSchool of Pharmacy, Queen’s University BelfastSchool of Business & Economics, National University of Ireland GalwayHRB Centre for Primary Care Research, Royal College of Surgeons in IrelandAbstract Background Multimorbidity, defined as the presence of at least two chronic conditions, becomes increasingly common in older people and is associated with poorer health outcomes and significant polypharmacy. The National Institute for Clinical Excellence (NICE) recently published a multimorbidity guideline that advises providing an individualised medication review for all people prescribed 15 or more repeat medicines. This study incorporates this guideline and aims to assess the effectiveness of a complex intervention designed to support general practitioners (GPs) to reduce potentially inappropriate prescribing and consider deprescribing in older people with multimorbidity and significant polypharmacy in Irish primary care. Methods This study is a cluster randomised controlled trial, involving 30 general practices and 450 patients throughout Ireland. Practices will be eligible to participate if they have at least 300 patients aged 65 years and over on their patient panel and if they use either one of the two predominant practice management software systems in use in Ireland. Using a software patient finder tool, practices will identify and recruit patients aged 65 years and over, who are prescribed at least 15 repeat medicines. Once baseline data collection is complete, practices will be randomised using minimisation by an independent third party to either intervention or control. Given the nature of the intervention, it is not possible to blind participants or study personnel. GPs in intervention practices will receive login details to a website where they will access training videos and a template for conducting an individualised structured medication review, which they will undertake with each of their included patients. Control practices will deliver usual care over the 6-month study period. Primary outcome measures pertain to the individual patient level and are the proportion of patients with any PIP and the number of repeat medicines. Discussion Disease-specific approaches in multimorbidity may be inappropriate and result in fragmented and poorly co-ordinated care. This pragmatic study is evaluating a complex intervention that is relevant across multiple conditions and addresses potential concerns around medicines safety in this vulnerable group of patients. The potential for system-wide implementation will be explored with a parallel mixed methods process evaluation. Trial registration ISRCTN: 12752680 , Registered 20 October 2016.http://link.springer.com/article/10.1186/s13012-017-0629-1Complex interventionMultimorbidityPolypharmacyPotentially inappropriate prescribing (PIP)DeprescribingPatient priorities |
| spellingShingle | Caroline McCarthy Barbara Clyne Derek Corrigan Fiona Boland Emma Wallace Frank Moriarty Tom Fahey Carmel Hughes Paddy Gillespie Susan M. Smith Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot Implementation Science Complex intervention Multimorbidity Polypharmacy Potentially inappropriate prescribing (PIP) Deprescribing Patient priorities |
| title | Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot |
| title_full | Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot |
| title_fullStr | Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot |
| title_full_unstemmed | Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot |
| title_short | Supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care (SPPiRE): a cluster randomised controlled trial protocol and pilot |
| title_sort | supporting prescribing in older people with multimorbidity and significant polypharmacy in primary care sppire a cluster randomised controlled trial protocol and pilot |
| topic | Complex intervention Multimorbidity Polypharmacy Potentially inappropriate prescribing (PIP) Deprescribing Patient priorities |
| url | http://link.springer.com/article/10.1186/s13012-017-0629-1 |
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