Safer Prescribing and Care for the Elderly (SPACE): a cluster randomised controlled trial in general practice

Katharine A Wallis; Carolyn Raina Elley; Simon A Moyes; Arier Lee; Joanna F Hikaka; Ngaire M Kerse

doi:10.3399/BJGPO.2021.0129

Safer Prescribing and Care for the Elderly (SPACE): a cluster randomised controlled trial in general practice

BJGP Open. 2022 Mar 22;6(1):BJGPO.2021.0129. doi: 10.3399/BJGPO.2021.0129. Print 2022 Mar.

Authors

Katharine A Wallis^{1

2}, Carolyn Raina Elley³, Simon A Moyes³, Arier Lee³, Joanna F Hikaka³, Ngaire M Kerse³

Affiliations

¹ Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Auckland, New Zealand k.wallis@uq.edu.au.
² Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³ Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Auckland, New Zealand.

Abstract

Background: Safer prescribing in general practice may help to decrease preventable adverse drug events (ADE) and related hospitalisations.

Aim: To test the effect of the Safer Prescribing and Care for the Elderly (SPACE) intervention on high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines and related hospitalisations.

Design & setting: A pragmatic cluster randomised controlled trial in general practice. Participants were patients at increased risk of ADEs from NSAIDs and/or antiplatelet medicines at baseline. SPACE comprises automated search to generate for each GP a list of patients with high-risk prescribing; pharmacist outreach to provide education and one-on-one review of list with GP; and automated letter inviting patients to seek medication review with their GP.

Method: The primary outcome was the difference in high-risk prescribing of NSAIDs and/or antiplatelet medicines at 6 months. Secondary outcomes were high-risk prescribing for gastrointestinal, renal, or cardiac ADEs separately, 12-month outcomes, and related ADE hospitalisations.

Results: Thirty-nine practices were recruited with 205 GPs and 191 593 patients, of which 21 877 (11.4%) were participants. Of the participants, 1479 (6.8%) had high-risk prescribing. High-risk prescribing improved in both groups at 6 and 12 months compared with baseline. At 6 months, there was no significant difference between groups (odds ratio [OR] 0.99; 95% confidence intervals [CI] = 0.87 to 1.13) although SPACE improved more for gastrointestinal ADEs (OR 0.81; 95% CI = 0.68 to 0.96). At 12 months, the control group improved more (OR 1.29; 95% CI = 1.11 to 1.49). There was no significant difference for related hospitalisations.

Conclusion: Further work is needed to identify scalable interventions that support safer prescribing in general practice. The use of automated search and feedback plus letter to patient warrants further exploration.

Keywords: anti-inflammatory agents, non-steroidal; drug-related side effects and adverse reactions; multimorbidity; polypharmacy; prescriptions; aged; family medicine; general practice; patient safety; primary healthcare.