Spider
Study Name: SPIDER: a Structured Process Informed by Data, Evidence and Research
Investigators: Neil Andrew Drummond
Affiliations:
Recruitment status:
Abstract
Background: Healthcare costs consume an alarming proportion of the gross domestic product (GDP) in Canada, increasing from 7% to 11% over a 40-year period. Half to two-thirds of healthcare costs in Canada are incurred by 5% of the population. Some of those patients are elders living with multiple chronic conditions; they may have unmet care needs. These patients may take many medications, some of which do not benefit them. An analysis of the University of Toronto Practice-Based Research Network’s (UTOPIAN’s) electronic medical record (EMR) data revealed that each family physician looks after, on average, 24 elderly patients who were prescribed ten or more different medications in the past year. Polypharmacy can be associated with elevated risks of poor health, reduced quality of life, high system costs as well as frustration for physicians.
Methods: An important area of practice transformation is systematic improvement of the quality of patient care. Quality improvement (QI) is an applied science that focuses on measurement and rapid-cycle tests of change in each local context while emphasizing sustainability and spread of effective change within and across healthcare systems. A complementary approach is that used in many research projects: follow rigorous steps to systematically collect evidence about the effectiveness of interventions implemented in the same way across multiple settings. SPIDER leverages existing relationships between QI experts and researchers and uses both approaches. SPIDER is jointly supported by Practice Based Research Networks (PBRNs) and QI programs and backed by research ready EMR data to improve care in primary care.
Objectives: The SPIDER (Structured Process Informed by Data, Evidence and Research) trial aims to improve healthcare for older adults experiencing polypharmacy by fostering safer, more informed prescribing practices in primary care. The central objective is to empower both patients and physicians to engage in meaningful conversations about medications, identifying those that may be unnecessary or potentially harmful. Reducing polypharmacy is expected to enhance patient health and care quality, while also improving workplace satisfaction among healthcare providers. The intervention focuses on medications commonly flagged for deprescribing in older adults, including proton pump inhibitors (PPIs), sedative-hypnotics such as benzodiazepines, antipsychotics used for agitation, and long-acting sulfonylureas associated with increased risk of hypoglycemia.