SPIDER: A Research & QI Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
NCT ID: NCT03689049
Last Updated: 2025-03-25
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
ENROLLING_BY_INVITATION
Clinical Phase
NA
Total Enrollment
104 participants
Study Classification
INTERVENTIONAL
Study Start Date
2018-03-26
Study Completion Date
2027-03-31
Brief Summary
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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.
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Detailed Description
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Polypharmacy is pervasive amongst elderly patients living with multiple chronic conditions and the prevalence is increasing. The Canadian Institute for Health Information recently reported that 26.5% Canadian seniors were prescribed ten or more different drugs in 2016. A member of our team (S. Dahrouge) has found that number of prescription proved to be the most reliable index of persistent complexity and high cost in patients 65 years or older. There is also an association between number of prescription and potentially inappropriate prescriptions (PIPs). Analyses conducted on 86 practices affiliated with the University of Toronto Practice Based Research Network (UTOPIAN) have found that family physicians look after a mean of 24 older patients prescribed ten or more medications each year. Polypharmacy in the elderly is associated with elevated risks of adverse drug reactions, frailty and falls. It also increases healthcare, drug, and hospitalization costs. While several medications can be problematic, the following four classes of PIPs have been specifically identified by Choosing Wisely Canada and the Canadian Deprescribing Network as targets for wiser uses in elders: proton pump inhibitors (PPIs), sedative hypnotics such as benzodiazepines, antipsychotics for agitation and medications with a higher risk of hypoglycemia such as long-acting sulfonylureas. To improve care for elderly patients living with polypharmacy, we propose SPIDER: a Structured Process Informed by Data, Evidence and Research. Leveraging existing Quality Improvement (QI) capacity and provision of validated EMR data, SPIDER will engage inter-professional practice teams. They will participate in Learning Collaboratives and work with QI Coaches to identify areas of improvement, develop strategies and implement changes to improve care. The study aims to assess whether SPIDER can reduce PIPs in older patients prescribed ten or more medications. Patient experience, provider satisfaction and cost-effectiveness of SPIDER will also be evaluated. The study will first be tested for feasibility in Toronto, Edmonton and Montreal. Findings will then guide a pragmatic cluster RCT in Calgary, Winnipeg, Ottawa, Montreal and Halifax where practices enrolled in the SPIDER intervention will be compared with those in usual care.
Conditions
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Polypharmacy
Inappropriate Prescribing
Aged
Primary Health Care
Quality Improvement
Electronic Health Records
Study Design
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Allocation Method
RANDOMIZED
Intervention Model
PARALLEL
The intervention will first be tested for feasibility using a single-arm, prospective, explanatory mixed approach. What we learn from the feasibility will then be applied to a 2-arm pragmatic cluster RCT where practices enrolled in the intervention group will be compared with those enrolled in the usual care group. Randomization will be at the practice level to avoid potential contamination where physicians practicing at the same location are enrolled in different arms.
Primary Study Purpose
HEALTH_SERVICES_RESEARCH
Blinding Strategy
NONE
Blinding of participants cannot be achieved in pragmatic trials of QI interventions in primary care.
Study Groups
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SPIDER
QI Learning Collaboratives.
Group Type
EXPERIMENTAL
SPIDER
Intervention Type
PROCEDURE
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
Intervention Type
PROCEDURE
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.
Usual Care
Standard primary care.
Group Type
PLACEBO_COMPARATOR
Usual Care
Intervention Type
PROCEDURE
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.
Interventions
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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.
Intervention Type
PROCEDURE
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.
Intervention Type
PROCEDURE
Eligibility Criteria
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Inclusion Criteria
1. At practice level: a) contributes EMR data to the repository of a Practice Based Research Network (PBRN) that participates in CPCSSN; and b) includes a primary care provider (PCP) who consents to participate and lead the practice QI team.
2. At PCP level: a) practices comprehensive family medicine in an office setting (academic or non-academic); and b) consents to participate and allow the research staff to provide study information to their eligible patients.
3. At patient level: a) 65 years or older; b) has at least one office visit during the past 2 years; and c) has received ten or more different prescription medications (as indicated in the EMR) in the past year.
2. At PCP level: a) practices comprehensive family medicine in an office setting (academic or non-academic); and b) consents to participate and allow the research staff to provide study information to their eligible patients.
3. At patient level: a) 65 years or older; b) has at least one office visit during the past 2 years; and c) has received ten or more different prescription medications (as indicated in the EMR) in the past year.
Exclusion Criteria
1. At practice level: a) Does not use EMR; b) does not contributes EMR data to the repository of a PBRN that participates in CPCSSN; or c) none of the PCPs at the practice consents to participate.
2. At PCP level: a) does not practice comprehensive family medicine in an office setting; b) does not consent to participate; c) does not allow the research staff to contact or provide study information to their eligible patients; or d) has left the practice.
3. At patient level: a) younger than 65 years of age; b) has not visited a practice over the past 2 years; or c) has received fewer than ten different prescription medications in the past year.
(Note:
* PBRN: Practice Based Research Network;
* CPCSSN: the Canadian Primary Care Sentinel Surveillance Network)
2. At PCP level: a) does not practice comprehensive family medicine in an office setting; b) does not consent to participate; c) does not allow the research staff to contact or provide study information to their eligible patients; or d) has left the practice.
3. At patient level: a) younger than 65 years of age; b) has not visited a practice over the past 2 years; or c) has received fewer than ten different prescription medications in the past year.
(Note:
* PBRN: Practice Based Research Network;
* CPCSSN: the Canadian Primary Care Sentinel Surveillance Network)
Minimum Eligible Age
65 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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Canadian Institutes of Health Research (CIHR)
OTHER_GOV
Sponsor Role
collaborator
University of Toronto
OTHER
Sponsor Role
collaborator
North York General Hospital
OTHER
Sponsor Role
collaborator
College of Family Physicians of Canada
OTHER
Sponsor Role
collaborator
University of Ottawa
OTHER
Sponsor Role
collaborator
University of Alberta
OTHER
Sponsor Role
collaborator
University of Calgary
OTHER
Sponsor Role
collaborator
University of Manitoba
OTHER
Sponsor Role
collaborator
Research Manitoba
OTHER
Sponsor Role
collaborator
Fonds de la Recherche en Santé du Québec
OTHER_GOV
Sponsor Role
collaborator
Université de Montréal
OTHER
Sponsor Role
collaborator
Nova Scotia Health Authority
OTHER
Sponsor Role
collaborator
Dalhousie University
OTHER
Sponsor Role
collaborator
Dalhousie Medical Research Foundation
UNKNOWN
Sponsor Role
collaborator
Doctors Nova Scotia
UNKNOWN
Sponsor Role
collaborator
Memorial University of Newfoundland
OTHER
Sponsor Role
collaborator
University of British Columbia
OTHER
Sponsor Role
collaborator
University of Toronto Practice Based Research Network
OTHER
Sponsor Role
lead
Responsible Party
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Responsibility Role
SPONSOR
Principal Investigators
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Michelle Greiver, MD
Role: PRINCIPAL_INVESTIGATOR
North York General Hospital
Locations
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Southern Alberta Primary Care Research Network (SAPCReN)
Calgary, Alberta, Canada
Site Status
Northern Alberta Primary Care Research Network (NAPCReN)
Edmonton, Alberta, Canada
Site Status
British Columbia node of the pan-Canadian CPCSSN (BC-CPCSSN)
Vancouver, British Columbia, Canada
Site Status
Manitoba Primary Care Research Network (MaPCReN)
Winnipeg, Manitoba, Canada
Site Status
Atlantic Practice Based Research Network (APBRN)
St. John's, Newfoundland and Labrador, Canada
Site Status
Maritime Family Practice Research Network (MaRNet-FP)
Halifax, Nova Scotia, Canada
Site Status
Ottawa Practice Enhancement Network (OPEN )
Ottawa, Ontario, Canada
Site Status
University of Toronto Practice Based Research Network
Toronto, Ontario, Canada
Site Status
Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM)
Laval, Quebec, Canada
Site Status
Countries
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Canada
References
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Berk ML, Monheit AC, Hagan MM. How the U.S. spent its health care dollar: 1929-1980. Health Aff (Millwood). 1988 Fall;7(4):46-60. doi: 10.1377/hlthaff.7.4.46. No abstract available.
Reference Type
BACKGROUND
Berk ML, Monheit AC. The concentration of health expenditures: an update. Health Aff (Millwood). 1992 Winter;11(4):145-9. doi: 10.1377/hlthaff.11.4.145.
Reference Type
BACKGROUND
Riley GF. Long-term trends in the concentration of Medicare spending. Health Aff (Millwood). 2007 May-Jun;26(3):808-16. doi: 10.1377/hlthaff.26.3.808.
Reference Type
BACKGROUND
Blumenthal D, Causino N, Chang YC, Culpepper L, Marder W, Saglam D, Stafford R, Starfield B. The duration of ambulatory visits to physicians. J Fam Pract. 1999 Apr;48(4):264-71.
Reference Type
BACKGROUND
Rais S, Nazerian A, Ardal S, Chechulin Y, Bains N, Malikov K. High-cost users of Ontario's healthcare services. Healthc Policy. 2013 Aug;9(1):44-51.
Reference Type
BACKGROUND
Chang HY, Boyd CM, Leff B, Lemke KW, Bodycombe DP, Weiner JP. Identifying Consistent High-cost Users in a Health Plan: Comparison of Alternative Prediction Models. Med Care. 2016 Sep;54(9):852-9. doi: 10.1097/MLR.0000000000000566.
Reference Type
BACKGROUND
Hochman M, Asch SM. Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations. J Gen Intern Med. 2017 Apr;32(4):392-397. doi: 10.1007/s11606-016-3945-2. Epub 2017 Feb 27.
Reference Type
BACKGROUND
Berk ML, Monheit AC. The concentration of health care expenditures, revisited. Health Aff (Millwood). 2001 Mar-Apr;20(2):9-18. doi: 10.1377/hlthaff.20.2.9.
Reference Type
BACKGROUND
Guilcher SJ, Bronskill SE, Guan J, Wodchis WP. Who Are the High-Cost Users? A Method for Person-Centred Attribution of Health Care Spending. PLoS One. 2016 Mar 3;11(3):e0149179. doi: 10.1371/journal.pone.0149179. eCollection 2016.
Reference Type
BACKGROUND
Tanuseputro P, Wodchis WP, Fowler R, Walker P, Bai YQ, Bronskill SE, Manuel D. The health care cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada. PLoS One. 2015 Mar 26;10(3):e0121759. doi: 10.1371/journal.pone.0121759. eCollection 2015.
Reference Type
BACKGROUND
Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf. 2016 Feb;7(1):11-22. doi: 10.1177/2042098615615472.
Reference Type
BACKGROUND
Reeve E, Ong M, Wu A, Jansen J, Petrovic M, Gnjidic D. A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017 Aug;73(8):927-935. doi: 10.1007/s00228-017-2257-8. Epub 2017 Apr 30.
Reference Type
BACKGROUND
Fletcher PC, Berg K, Dalby DM, Hirdes JP. Risk factors for falling among community-based seniors. J Patient Saf. 2009 Jun;5(2):61-6. doi: 10.1097/PTS.0b013e3181a551ed.
Reference Type
BACKGROUND
Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014 Jun;174(6):890-8. doi: 10.1001/jamainternmed.2014.949.
Reference Type
BACKGROUND
Lindblad CI, Hanlon JT, Gross CR, Sloane RJ, Pieper CF, Hajjar ER, Ruby CM, Schmader KE, Multidisciplinary Consensus Panel. Clinically important drug-disease interactions and their prevalence in older adults. Clin Ther. 2006 Aug;28(8):1133-1143. doi: 10.1016/j.clinthera.2006.08.006.
Reference Type
BACKGROUND
Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003 Mar 5;289(9):1107-16. doi: 10.1001/jama.289.9.1107.
Reference Type
BACKGROUND
Barry HE, Cooper JA, Ryan C, Passmore AP, Robinson AL, Molloy GJ, Darcy CM, Buchanan H, Hughes CM. Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database. J Alzheimers Dis. 2016 Apr 11;52(4):1503-13. doi: 10.3233/JAD-151177.
Reference Type
BACKGROUND
Hovstadius B, Petersson G. The impact of increasing polypharmacy on prescribed drug expenditure-a register-based study in Sweden 2005-2009. Health Policy. 2013 Feb;109(2):166-74. doi: 10.1016/j.healthpol.2012.09.005. Epub 2012 Nov 26.
Reference Type
BACKGROUND
Akazawa M, Imai H, Igarashi A, Tsutani K. Potentially inappropriate medication use in elderly Japanese patients. Am J Geriatr Pharmacother. 2010 Apr;8(2):146-60. doi: 10.1016/j.amjopharm.2010.03.005.
Reference Type
BACKGROUND
Morgan SG, Hunt J, Rioux J, Proulx J, Weymann D, Tannenbaum C. Frequency and cost of potentially inappropriate prescribing for older adults: a cross-sectional study. CMAJ Open. 2016 Jun 22;4(2):E346-51. doi: 10.9778/cmajo.20150131. eCollection 2016 Apr-Jun.
Reference Type
BACKGROUND
Steinberg M, Lyketsos CG. Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry. 2012 Sep;169(9):900-6. doi: 10.1176/appi.ajp.2012.12030342.
Reference Type
BACKGROUND
Pollock K, Grime J. The cost and cost-effectiveness of PPIs--GP perspectives and responses to a prescribing dilemma and their implications for the development of patient-centred healthcare. Eur J Gen Pract. 2003 Dec;9(4):126-33, 140. doi: 10.3109/13814780309160421.
Reference Type
BACKGROUND
Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005 Dec 1;353(22):2335-41. doi: 10.1056/NEJMoa052827.
Reference Type
BACKGROUND
Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, Rojas-Fernandez C, Walsh K, Welch V, Moayyedi P. Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017 May;63(5):354-364.
Reference Type
BACKGROUND
Hogan DB, Maxwell CJ, Fung TS, Ebly EM; Canadian Study of Health and Aging. Prevalence and potential consequences of benzodiazepine use in senior citizens: results from the Canadian Study of Health and Aging. Can J Clin Pharmacol. 2003 Summer;10(2):72-7.
Reference Type
BACKGROUND
Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Zolpidem use and hip fractures in older people. J Am Geriatr Soc. 2001 Dec;49(12):1685-90. doi: 10.1111/j.1532-5415.2001.49280.x.
Reference Type
BACKGROUND
Tannenbaum C, Farrell B, Shaw J, Morgan S, Trimble J, Currie J, Turner J, Rochon P, Silvius J. An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network. Can J Aging. 2017 Mar;36(1):97-107. doi: 10.1017/S0714980816000702. Epub 2017 Jan 16.
Reference Type
BACKGROUND
Garfinkel D, Ilhan B, Bahat G. Routine deprescribing of chronic medications to combat polypharmacy. Ther Adv Drug Saf. 2015 Dec;6(6):212-33. doi: 10.1177/2042098615613984.
Reference Type
BACKGROUND
Thompson W, Hogel M, Li Y, Thavorn K, O'Donnell D, McCarthy L, Dolovich L, Black C, Farrell B. Effect of a Proton Pump Inhibitor Deprescribing Guideline on Drug Usage and Costs in Long-Term Care. J Am Med Dir Assoc. 2016 Jul 1;17(7):673.e1-4. doi: 10.1016/j.jamda.2016.04.020. Epub 2016 Jun 8.
Reference Type
BACKGROUND
Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016 Sep;82(3):583-623. doi: 10.1111/bcp.12975. Epub 2016 Jun 13.
Reference Type
BACKGROUND
Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021-31. doi: 10.2165/0002512-200825120-00004.
Reference Type
BACKGROUND
Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, Bonner C, Doust J, Colvin J, Heaney A, Turner R, McCaffery K. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016 Jun 3;353:i2893. doi: 10.1136/bmj.i2893. No abstract available.
Reference Type
BACKGROUND
Boulin M, Diaby V, Tannenbaum C. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada. PLoS One. 2016 Sep 20;11(9):e0162951. doi: 10.1371/journal.pone.0162951. eCollection 2016.
Reference Type
BACKGROUND
Farrell B, Black C, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, Shamji S, Upshur R, Bouchard M, Welch V. Deprescribing antihyperglycemic agents in older persons: Evidence-based clinical practice guideline. Can Fam Physician. 2017 Nov;63(11):832-843.
Reference Type
BACKGROUND
Schmader KE, Hanlon JT, Pieper CF, Sloane R, Ruby CM, Twersky J, Francis SD, Branch LG, Lindblad CI, Artz M, Weinberger M, Feussner JR, Cohen HJ. Effects of geriatric evaluation and management on adverse drug reactions and suboptimal prescribing in the frail elderly. Am J Med. 2004 Mar 15;116(6):394-401. doi: 10.1016/j.amjmed.2003.10.031.
Reference Type
BACKGROUND
Spinewine A, Swine C, Dhillon S, Lambert P, Nachega JB, Wilmotte L, Tulkens PM. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007 May;55(5):658-65. doi: 10.1111/j.1532-5415.2007.01132.x.
Reference Type
BACKGROUND
Herxheimer A, McGettigan P. Problems of polypharmacy. BMJ. 2013 Dec 23;347:f7500. doi: 10.1136/bmj.f7500. No abstract available.
Reference Type
BACKGROUND
Frank C, Weir E. Deprescribing for older patients. CMAJ. 2014 Dec 9;186(18):1369-76. doi: 10.1503/cmaj.131873. Epub 2014 Sep 2. No abstract available.
Reference Type
BACKGROUND
Lenander C, Elfsson B, Danielsson B, Midlov P, Hasselstrom J. Effects of a pharmacist-led structured medication review in primary care on drug-related problems and hospital admission rates: a randomized controlled trial. Scand J Prim Health Care. 2014 Dec;32(4):180-6. doi: 10.3109/02813432.2014.972062. Epub 2014 Oct 27.
Reference Type
BACKGROUND
Bokhof B, Junius-Walker U. Reducing Polypharmacy from the Perspectives of General Practitioners and Older Patients: A Synthesis of Qualitative Studies. Drugs Aging. 2016 Apr;33(4):249-66. doi: 10.1007/s40266-016-0354-5.
Reference Type
BACKGROUND
Birtwhistle R, Keshavjee K, Lambert-Lanning A, Godwin M, Greiver M, Manca D, Lagace C. Building a pan-Canadian primary care sentinel surveillance network: initial development and moving forward. J Am Board Fam Med. 2009 Jul-Aug;22(4):412-22. doi: 10.3122/jabfm.2009.04.090081.
Reference Type
BACKGROUND
Mold JW, Peterson KA. Primary care practice-based research networks: working at the interface between research and quality improvement. Ann Fam Med. 2005 May-Jun;3 Suppl 1(Suppl 1):S12-20. doi: 10.1370/afm.303.
Reference Type
BACKGROUND
Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, Tunis S, Bergel E, Harvey I, Magid DJ, Chalkidou K. A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. CMAJ. 2009 May 12;180(10):E47-57. doi: 10.1503/cmaj.090523. Epub 2009 Apr 16. No abstract available.
Reference Type
BACKGROUND
Schwartz D, Lellouch J. Explanatory and pragmatic attitudes in therapeutical trials. J Chronic Dis. 1967 Aug;20(8):637-48. doi: 10.1016/0021-9681(67)90041-0. No abstract available.
Reference Type
BACKGROUND
Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P; CONSORT Group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008 Feb 19;148(4):295-309. doi: 10.7326/0003-4819-148-4-200802190-00008.
Reference Type
BACKGROUND
Campbell MK, Piaggio G, Elbourne DR, Altman DG; CONSORT Group. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012 Sep 4;345:e5661. doi: 10.1136/bmj.e5661. No abstract available.
Reference Type
BACKGROUND
Brehaut JC, Colquhoun HL, Eva KW, Carroll K, Sales A, Michie S, Ivers N, Grimshaw JM. Practice Feedback Interventions: 15 Suggestions for Optimizing Effectiveness. Ann Intern Med. 2016 Mar 15;164(6):435-41. doi: 10.7326/M15-2248. Epub 2016 Feb 23.
Reference Type
BACKGROUND
Linsky A, Simon SR, Stolzmann K, Meterko M. Patient Perceptions of Deprescribing: Survey Development and Psychometric Assessment. Med Care. 2017 Mar;55(3):306-313. doi: 10.1097/MLR.0000000000000642.
Reference Type
BACKGROUND
Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013 Oct;30(10):793-807. doi: 10.1007/s40266-013-0106-8.
Reference Type
BACKGROUND
Turner JP, Edwards S, Stanners M, Shakib S, Bell JS. What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open. 2016 Mar 10;6(3):e009781. doi: 10.1136/bmjopen-2015-009781.
Reference Type
BACKGROUND
Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017 Jan 26;17(1):88. doi: 10.1186/s12913-017-2031-8.
Reference Type
BACKGROUND
Montiel-Luque A, Nunez-Montenegro AJ, Martin-Aurioles E, Canca-Sanchez JC, Toro-Toro MC, Gonzalez-Correa JA; Polipresact Research Group. Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PLoS One. 2017 Feb 6;12(2):e0171320. doi: 10.1371/journal.pone.0171320. eCollection 2017.
Reference Type
BACKGROUND
MacCarthy D, Kallstrom L, Kadlec H, Hollander M. Improving primary care in British Columbia, Canada: evaluation of a peer-to-peer continuing education program for family physicians. BMC Med Educ. 2012 Nov 9;12:110. doi: 10.1186/1472-6920-12-110.
Reference Type
BACKGROUND
Farrell B, Richardson L, Raman-Wilms L, de Launay D, Alsabbagh MW, Conklin J. Self-efficacy for deprescribing: A survey for health care professionals using evidence-based deprescribing guidelines. Res Social Adm Pharm. 2018 Jan;14(1):18-25. doi: 10.1016/j.sapharm.2017.01.003. Epub 2017 Jan 28.
Reference Type
BACKGROUND
Green LA, White LL, Barry HC, Nease DE Jr, Hudson BL. Infrastructure requirements for practice-based research networks. Ann Fam Med. 2005 May-Jun;3 Suppl 1(Suppl 1):S5-11. doi: 10.1370/afm.299.
Reference Type
BACKGROUND
Bello AK, Ronksley PE, Tangri N, Singer A, Grill A, Nitsch D, Queenan JA, Lindeman C, Soos B, Freiheit E, Tuot D, Mangin D, Drummond N. A national surveillance project on chronic kidney disease management in Canadian primary care: a study protocol. BMJ Open. 2017 Aug 4;7(8):e016267. doi: 10.1136/bmjopen-2017-016267.
Reference Type
BACKGROUND
Southgate D, Greiver M, Hubka G, Kostka K, Moineddin R, Moienedin M, Pencharz J, Bogetta H, Mazariegos C, Guindon JA, Petroff A. Effect of a Group Behavioural Management Program on Emotional Regulation of Food Choices: A Pilot Randomized Controlled Trial. Can J Diet Pract Res. 2017 Sep 1;78(3):137-140. doi: 10.3148/cjdpr-2017-006. Epub 2017 Mar 23.
Reference Type
BACKGROUND
Vickers AJ, Altman DG. Statistics notes: Analysing controlled trials with baseline and follow up measurements. BMJ. 2001 Nov 10;323(7321):1123-4. doi: 10.1136/bmj.323.7321.1123. No abstract available.
Reference Type
BACKGROUND
Udow-Phillips M, Ehrlich E, Kofke-Egger H. Health Care Cost Drivers: Chronic Disease, Comorbidity, and Health Risk Factors in the U.S. and Michigan | Center for Healthcare Research & Transformation. Ann Arbor: Center for Healthcare Research & Transformation 2010.
Reference Type
BACKGROUND
Moturu S, Johnson W, Liu H. Predictive risk modelling for forecasting high-cost patients: A real-world application using Medicaid data. International Journal Biomedical Engineering and Technology. 2010;3(1-2):114-132.
Reference Type
BACKGROUND
Wodchis W, Austin P, Newman A, Carollo A, Henry D. The Concentration of Health Care Spending: Little Ado (yet) About Much (money). 2012; https://www.cahspr.ca/en/presentation/5244423937dee8014beea024.
Reference Type
BACKGROUND
Glazier R, Agha M, Creatore M, Gozdyra P. High Cost Health Care Users: A Focus on Health Links. 2017. http://www.torontohealthprofiles.ca/a_documents/aboutTheData/HealthQualityTablepresentationOnHighUsers.pdf.
Reference Type
BACKGROUND
The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. 2003. http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx.
Reference Type
BACKGROUND
Dahrouge S, Wodchis W. Identifying high users in Ontario - an algorithm for use in primary care practices. 2017;In press.
Reference Type
BACKGROUND
Canadian Deprescribing Network: Deprescribing algorithms. 2017; https://www.deprescribingnetwork.ca/algorithms/.
Reference Type
BACKGROUND
Donner A. Some aspects of the design and analysis of cluster randomization trials. Appl Stat. 1998;47:95-113.
Reference Type
BACKGROUND
Romanow R. Building on values: the future of health care in Canada. Ottawa2002.
Reference Type
BACKGROUND
Clement S. The self-efficacy expectations and occupational preferences of females and males. Journal of Occupational Psychology. 1987;60(3):257-265.
Reference Type
BACKGROUND
Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V. High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res. 2014 Oct 31;14:532. doi: 10.1186/s12913-014-0532-2.
Reference Type
BACKGROUND
Wodchis W, Bushmeneva K, Nikitović M, McKillop IH, McKillop E. Guidelines on Person-level Costing Using Administrative Databases in Ontario. Working Paper Series. Vol 1. 2013.
Reference Type
BACKGROUND
Wodchis WP, Austin PC, Henry DA. A 3-year study of high-cost users of health care. CMAJ. 2016 Feb 16;188(3):182-188. doi: 10.1503/cmaj.150064. Epub 2016 Jan 11.
Reference Type
BACKGROUND
WHO Collaborating Centre for drug statistic methodology - ATC/DDD Index. 2017; https://www.whocc.no/atc_ddd_index/.
Reference Type
BACKGROUND
Greiver M, Martin K, Aliarzadeh B, Lambert-Lanning A, Leggett J. Implementing a scalable tool for quality improvement in primary care: a report for Canada Health Infoway. Toronto December 2013.
Reference Type
BACKGROUND
Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R, Lam M, Seguin R. Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity. BMC Med Res Methodol. 2003 Dec 22;3:28. doi: 10.1186/1471-2288-3-28.
Reference Type
BACKGROUND
Garies S, Birtwhistle R, Drummond N, Queenan J, Williamson T. Data Resource Profile: National electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Int J Epidemiol. 2017 Aug 1;46(4):1091-1092f. doi: 10.1093/ije/dyw248. No abstract available.
Reference Type
BACKGROUND
Williamson T, Green ME, Birtwhistle R, Khan S, Garies S, Wong ST, Natarajan N, Manca D, Drummond N. Validating the 8 CPCSSN case definitions for chronic disease surveillance in a primary care database of electronic health records. Ann Fam Med. 2014 Jul;12(4):367-72. doi: 10.1370/afm.1644.
Reference Type
BACKGROUND
Queenan JA, Williamson T, Khan S, Drummond N, Garies S, Morkem R, Birtwhistle R. Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study. CMAJ Open. 2016 Jan 25;4(1):E28-32. doi: 10.9778/cmajo.20140128. eCollection 2016 Jan-Mar.
Reference Type
BACKGROUND
Coons MJ, Greiver M, Aliarzadeh B, Meaney C, Moineddin R, Williamson T, Queenan J, Yu CH, White DG, Kiran T, Kane JJ. Is glycemia control in Canadians with diabetes individualized? A cross-sectional observational study. BMJ Open Diabetes Res Care. 2017 Jun 8;5(1):e000316. doi: 10.1136/bmjdrc-2016-000316. eCollection 2017.
Reference Type
BACKGROUND
Morkem R, Williamson T, Patten S, Queenan JA, Wong ST, Manca D, Barber D. Trends in antidepressant prescribing to children and adolescents in Canadian primary care: A time-series analysis. Pharmacoepidemiol Drug Saf. 2017 Sep;26(9):1093-1099. doi: 10.1002/pds.4240. Epub 2017 Jun 8.
Reference Type
BACKGROUND
Greiver M, Williamson T, Barber D, Birtwhistle R, Aliarzadeh B, Khan S, Morkem R, Halas G, Harris S, Katz A. Prevalence and epidemiology of diabetes in Canadian primary care practices: a report from the Canadian Primary Care Sentinel Surveillance Network. Can J Diabetes. 2014 Jun;38(3):179-85. doi: 10.1016/j.jcjd.2014.02.030. Epub 2014 May 14.
Reference Type
BACKGROUND
Patton M. Qualitative evaluation and research methods. 2nd ed. Newbery Park, CA: Sage Publication; 1990.
Reference Type
BACKGROUND
Sopcak N, Aguilar C, O'Brien MA, Nykiforuk C, Aubrey-Bassler K, Cullen R, Grunfeld E, Manca DP. Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care. Implement Sci. 2016 Dec 1;11(1):158. doi: 10.1186/s13012-016-0525-0.
Reference Type
BACKGROUND
Glaser B, Strauss A. The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter; 1967.
Reference Type
BACKGROUND
Strauss A, Corbin J. Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage; 1990.
Reference Type
BACKGROUND
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006 Winter;26(1):13-24. doi: 10.1002/chp.47.
Reference Type
BACKGROUND
UTOPIAN Idea to Proposal Course (I2P). 2016; http://www.dfcm.utoronto.ca/utopian-idea-proposal-course-i2p.
Reference Type
BACKGROUND
Grant A, Dreischulte T, Guthrie B. Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing. BMJ Open. 2017 Mar 10;7(3):e015281. doi: 10.1136/bmjopen-2016-015281.
Reference Type
BACKGROUND
Helfrich CD, Li YF, Sharp ND, Sales AE. Organizational readiness to change assessment (ORCA): development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework. Implement Sci. 2009 Jul 14;4:38. doi: 10.1186/1748-5908-4-38.
Reference Type
BACKGROUND
Greiver M, Dahrouge S, O'Brien P, Manca D, Lussier MT, Wang J, Burge F, Grandy M, Singer A, Twohig M, Moineddin R, Kalia S, Aliarzadeh B, Ivers N, Garies S, Turner JP, Farrell B. Improving care for elderly patients living with polypharmacy: protocol for a pragmatic cluster randomized trial in community-based primary care practices in Canada. Implement Sci. 2019 Jun 6;14(1):55. doi: 10.1186/s13012-019-0904-4.
Reference Type
DERIVED
Provided Documents
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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form
Other Identifiers
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KPG-156886
Identifier Type: -
Identifier Source: org_study_id
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