Update: PRACTICE RECRUITMENT STARTING 12 APRIL 2017.
Older people tend to have multimorbidity, requiring multiple medications. One in five Irish adults aged 50, and almost half of those aged 75 years, take five or more regular medications. These combined health care needs, coupled with age-related changes in how the body processes medications, make prescribing in this population a complex task. Consequently, evidence indicates that prescribing in older people is often suboptimal, with an increased risk for adverse outcomes including drug-drug interactions, adverse drug reactions, and poorer health related quality of life. It is therefore important to optimise prescribing in this population to increase patient safety and health outcomes.
Interventions targeting improved prescribing represent an important public health measure, particularly in primary care, where the majority of prescribing takes place. However, no single best interventional strategy has proved to be most effective. The aim of this study is to investigate the effectiveness of a computerised decision support system (CDSS) intervention in supporting prescribing decisions and improving outcomes in older people with multimorbidity and complex polypharmacy (>15 regular medicines) in Irish primary care.
Study design and recruitment
A pragmatic two arm cluster randomised controlled trial will be conducted in Irish primary care.
Eligible GP practices will be invited to participate by formal email and/or letter, supported by a trial information leaflet detailing the steps of the intervention, and requested to sign a practice agreement.
Practices will be eligible to participate where:
- They have approximately 300 or more older patients (aged ≥65 years) on their patient panel
- They use Socrates or Health One practice management system
Practices who agree to participate in this trial will be randomised to either intervention or control group.
Intervention group (the CDSS intervention): GPs will be provided with a software search tool to identify patients on selected medications and given access to online materials to support them to conduct a medication review for that patient.
Control group: GPs will use the software search tool to identify patients for the study and will continue to provide usual care for patients for the study duration. Upon study completion, all control group GPs will have access to the CDSS.
In addition, all practices taking part in the trial will be supported to undertake their CPD audit fulfilling Medical Council requirements.
This trial is funded by the HRB under the Network set-up grant and led by Network academics at the Royal College of Surgeons in Ireland Dublin.