Abstract Body

Background and purpose

The SPPiRE trial aimed to assess the effectiveness of a GP-delivered intervention in reducing significant polypharmacy and potentially inappropriate prescribing (PIP) in older people with multimorbidity in Irish primary care.

Methods

We conducted a cluster-randomised controlled trial among 51 practices and 404 patients aged ≥65 years and prescribed ≥15 medicines. Following baseline data collection, practices were allocated using minimisation for location and size. Intervention GPs received educational support material and conducted web-based individualised medication reviews with participants. Control GPs delivered usual care. An independent blinded pharmacist assessed primary outcome measures which were the number of repeat medicines and the proportion of patients with any PIP (STOPP/START V2). We performed intention-to-treat analysis using random-effects regression.

Results

Recruited participants had significant disease and treatment burden at baseline, mean age 76.51 years (SD 6.52) and mean number of medicines 17.21 (SD 3.54). Interim analysis of 90% of patients followed up to date indicate a small but significant reduction in the number of medicines in the intervention group (IRR 0.95, 95%CI; 0.89–0.99, p=0.03). The adjusted odds of having at least one PIP in the intervention versus control group is 0.32 (95%CI; 0.11–0.94, p=0.04), though interpretation of this measure is limited by the low numbers with no PIP, and an inconclusive effect on secondary PIP measures.

Conclusions

Interim results suggest that the SPPiRE intervention is effective in reducing the number of medicines but the effect on PIP is unclear. Given the challenges recruiting, retaining and engaging this patient group, future similar studies should focus on patients who have moderate but not severe disease burden.