Supporting prescribing in older patient with multimorbidity in primary care (SPPiRE) is a cluster randomised controlled trial that was designed to assess the effectiveness of a web guided medication review in reducing potentially inappropriate prescribing and polypharmacy in patients aged ≥ 65 years who are prescribed ≥ 15 medicines, in Irish primary care.

I suggest you review your EBM notes about randomised controlled trial design. This is a cluster randomised controlled trial, meaning groups or “clusters” are randomised together. This is done to avoid contamination, as the intervention is being delivered by GPs and it would be difficult for a GP to treat their own patients differently. Each GP practice is randomised as one

I also suggest you look up the CONSORT reporting requirements for randomised controlled trials.

Population:

Patients aged ≥ 65 years who are prescribed ≥ 15 medicines, in Irish primary care

Intervention:

Web guided medication review and professional training videos

Control:

Usual GP care

Outcome measures:

Primary outcome measure:

Number of repeat medicines

Proportion of patients with at least 1 PIP

Secondary outcome measures:

Health related quality of life

Multimorbidity treatment burden questionnaire

Patients attitudes to deprescribing

GP reported health care utilisation

I suggest that your literature review should be on medication review guidelines and the evidence for medication reviews.

Here is a recommended reading list for your literature review:

· https://www.ncbi.nlm.nih.gov/pubmed/28764753 (the trial’s protocol)

· https://www.icgp.ie/speck/properties/asset/asset.cfm?type=LibraryAsset&id=0329F12C%2D4355%2D4E18%2D8DC194DF812DB2E7&property=asset&revision=tip&disposition=inline&app=icgp&filename=Med%5FReview%5FQRG%2Epdf (Irish College of General Practitioners quick reference guide on medication reviews, this document will give an overview on what potentially inappropriate prescribing is, and why it is important to address).

· https://www.ncbi.nlm.nih.gov/pubmed/17630041 (review article on appropriate prescribing and polypharmacy in the elderly)

· https://www.ncbi.nlm.nih.gov/pubmed/27321600 (Systematic review on interventions to improve prescribing in the elderly)

· https://www.ncbi.nlm.nih.gov/pubmed/22500541 (review article on “deprescribing”)

I also suggest you look at the following clinical guidelines in addition to the ICGP medication review reference guide above:

?         SIGN Polypharmacy guidelines

?         NICE multimorbidity guidelines

?         NICE medication optimisation guidelines

pur-new-sol

Related Questions

Population:	Patients aged ≥ 65 years who are prescribed ≥ 15 medicines, in Irish primary care
Intervention:	Web guided medication review and professional training videos
Control:	Usual GP care
Outcome measures:	Primary outcome measure: Number of repeat medicines Proportion of patients with at least 1 PIP Secondary outcome measures: Health related quality of life Multimorbidity treatment burden questionnaire Patients attitudes to deprescribing GP reported health care utilisation