Forthcoming National Research

Multimorbidity, defined as the co-occurrence of at least two chronic conditions in an individual is associated with poorer health outcomes and higher health service utilisation and it is a key challenge facing health systems. The HRB Primary Care Clinical Trials Network is supporting a national GP-based study funded by the Health Research Board in Ireland called “Medicines and Social Prescribing to aDdress pAtient priorities in multimorbidity (MIDAS): A multi-arm definitive cluster randomised trial in Irish general practice”. 

The MIDAS study is led by Professor Susan Smith in Trinity College Dublin’s Discipline of Public Health and Primary Care. It aims to evaluate two interventions that will support GP teams providing CDM care with a focus on people taking 10 or more medicines, which is a marker of more complex multimorbidity. One intervention involves a GP-based pharmacist to support medicines reviews and the other is a practice based link worker delivering social prescribing to address patient goals and priorities. The study is commencing in March 2024 and we will then be actively recruiting general practices involved in the CDM programme.

GPs report challenges managing complex polypharmacy and patients focus on the need to support improvements in their daily functioning and activities. International guidelines suggest that medicines management interventions which address the number and appropriateness of medicines need to be targeted at those with more significant polypharmacy. This recommendation has been confirmed by our previous research that has informed MIDAS including a series of systematic reviews and three pilot trials conducted in Irish general practices. Both the MyComrade pilot cRCT and the GP-based Pharmacist cluster RCT targeted patients taking 10 or more regular medicines and confirmed that both practice staff and patients found the intervention acceptable and reported strong fidelity to the intervention components. A second pilot RCT, the LinkMM study evaluated GP-based link workers providing social prescribing and indicated that practice-based link workers were feasible and acceptable to patients. We plan to evaluate both interventions in a national cluster RCT that embeds recruitment and intervention delivery into the national CDM program.

MIDAS will run for a three year period and recruit 48 diverse general practices across the country and 672 patients. Practices will be randomised into one of three groups, to pharmacist support (MyComrade),or link worker support (LinkMM) or to a control group continuing with usual care. A broad range of outcomes will be collected from patients at baseline and after six months of the intervention, when the study will finish. Practices will be resourced for their time participating in the study.

Patients with 2+ chronic conditions taking 10+medicines in participating practices who are due for a CDM review will be invited by GP nurses to join the study and consent and baseline data will be collected. When approximately 16 patients have been recruited, the practice will then be randomly allocated to MyComrade, LinkMM or Usual Care. In the MyComrade practices, a pharmacist will be based in the practice for one session per week and in the LinkMM practices it will be 2 sessions per week. The pharmacist and link worker will be employed by the Study Centre in TCD and will focus on the 16 study patients in each practice but can also engage more generally with the practice.

• Free access, for six months, to a pharmacist for one session for a week or a link worker for two sessions a week or, if randomised to control, access to all study material at study end.
• Support in completing IMC mandatory audit guidelines.
• Financial payments for sign on and individual patient recruitment.
• Participation in a large national general practice multi-arm trial (Ireland’s first).

MIDAS is supported by a Patient and Public Involvement group with specific experience in studies examining multiple conditions. They will stay involved throughout to ensure we conduct research that matters to patients.

Expressions of interest can be sent directly to the Study Manager, Farah Tahsin: tahsinf@tcd.ie