1 out of 4 Canadian seniors (26.5%) are on 10 or more different medications. Some of these medications could be harmful to seniors: increasing the risk of confusion, falls, or hospitalizations. Stopping drugs, or de-prescribing, could help.
Our project, a Structured Process Informed by Data, Evidence and Research (SPIDER), is a large community based and community-informed project designed to test and implement effective approaches to de-prescribing. We target potentially inappropriate prescriptions (PIPs).
The SPIDER approach includes the provision of electronic medical record (EMR) data to support participating practice teams in exchanging learnings. In such, Family Practices learn and work together to improve care for elderly patients taking many medications.
SPIDER was conceived and is being implemented in partnership with Patients and Communities. The perspectives of patients and communities are heard, improving the quality and relevance of the project. SPIDER involves Primary Care Practice Based Research and Learning Networks (PBRLNs) in seven provinces across Canada. Following successful feasibility testing in 3 centres, we have initiated a Randomized Controlled Trial to test this approach in seven centers.
The trial compares the SPIDER approach to usual care for seniors on ten or more medications. Outcomes include fewer potentially inappropriate medications, and are measured in terms of better care, better patient experience, cost effectiveness, and better work lives for primary care team members - the quadruple aim. If SPIDER proves to be successful for this complex community-based population, the model could be used to improve other aspects of care.
SPIDER is one of the largest community-based trials in Canada. It has received $1Million in funding from the Canadian Institutes of Health Research, and matching funding of $1.6Million from partners across Canada. It has recently received an additional $150,000 from the Primary Care Research Network to expand in British Columbia (led by Dr Rubee Dev) and Newfoundland (led by Dr Kris Aubrey-Bassler). SPIDER includes patients, pharmacists, family physicians, nurses, nurse practitioners, experts in de-prescribing, audit & feedback and practice facilitation, and researchers from across Canada. Health care sites include Community Health Centres, inter-professional academic and community-based primary care organizations and family physicians in small community practices. SPIDER has received several awards for Quality Improvement including acknowledgement as the People’s Choice Award for best poster during an international conference.
Here is what Dr. Martin Shack, a solo family physician and one of the People’s Choice Award winners says about his experience:
“Working in the SPIDER project was eye-opening at first because it gave me a chance to really see the data in my practice up close and personal. My own estimations as to how many elderly patients would’ve qualified were extremely far off. The ability to work with a pharmacist who came into my office and saw patients in my office and initiate change was an extremely positive experience. Overall, this was of great value for both for myself and my patients.”
A key lesson for us is adaptability during the pandemic. All in-person meetings were halted; SPIDER rapidly shifted to virtual Learning Collaboratives. As a result, the Ontario portion of the Randomized Controlled Trial, centered in Ottawa, was able to spread to provincial community-based engagement and now includes participants from other Ontario Networks.
SPIDER’s feasibility work found high levels of engagements from the teams, and trends in reductions in potentially inappropriate prescriptions for complex seniors. Virtual Learning Collaboratives are now completed or in progress in five Networks taking part in the RCT, with two additional Networks joining in 2023.
Posters, presentations, and publications can be found here.
SPIDER is community-based research, designed with rigour and attention to impact. Our experience as participants in SPIDER enables us to share with confidence our belief the ability of this de-prescribing effort to contribute toward the quadruple aim - better care, better patient experience, cost-effectiveness, and better team experience.
For more information on SPIDER:
Visit the website: https://www.spiderdeprescribing.com/
Key contacts:
Michelle Greiver, Simone Dahrouge, and Renata Musa Michelle.greiver@nygh.on.ca 416-978-5113 500 University Avenue, 3F, Toronto ON M5G 1V7