PolypharmacySPIDERNCT03689049
SPIDER: A Research & QI Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
A study testing SPIDER in people with Polypharmacy and Inappropriate Prescribing, run by University of Toronto Practice Based Research Network at 9 sites in Canada.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 65 years and older
- Conditions the study is for
- Polypharmacy, Inappropriate Prescribing, Aged
- What is being tested?
- SPIDER
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 104 participants
- Where
- 9 sitesCanada
- Study dates
- 26 Mar 2018to 31 Mar 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 65 years and older
- All sexes
- No healthy volunteers
- Older adult
Who may be able to join
- 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.
- 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.
- 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.
Who cannot join
- 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.
- 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.
- 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)
Trial locations and contacts
9 sites in 1 country.
9 sites in 1 country
Canada9 sites
Southern Alberta Primary Care Research Network (SAPCReN)
Calgary, Alberta, T2N 4N1
Northern Alberta Primary Care Research Network (NAPCReN)
Edmonton, Alberta, T6G 2T4
Maritime Family Practice Research Network (MaRNet-FP)
Halifax, Nova Scotia, B3H 2E2
Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM)
Laval, Quebec, H7M 3L9
Ottawa Practice Enhancement Network (OPEN )
Ottawa, Ontario, K1R 7G5
Atlantic Practice Based Research Network (APBRN)
St. John's, Newfoundland and Labrador, A1B 3V6
University of Toronto Practice Based Research Network
Toronto, Ontario, M5G 1V7
British Columbia node of the pan-Canadian CPCSSN (BC-CPCSSN)
Vancouver, British Columbia, V6T 2B5
Manitoba Primary Care Research Network (MaPCReN)
Winnipeg, Manitoba, R3E 0T6
About this study
Official title: SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
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.
Read the detailed description
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
- Polypharmacy, Inappropriate Prescribing, Aged, Primary Health Care, Quality Improvement, Electronic Health Records
- Being tested
- SPIDER, Usual Care
- Keywords
- Polypharmacy, Deprescribing, Aged Adult, Elderly Patient, Primary Health Care, Quality Improvement, Practice Facilitation, Learning Collaborative, Electronic Medical Records (EMR)
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
SPIDERProcedure or surgery
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 CareProcedure or surgery
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.
| Study group | Role | What they receive |
|---|---|---|
| SPIDER | Experimental | QI Learning Collaboratives. Receives: Procedure: SPIDER; Procedure: Usual Care |
| Usual Care | Placebo comparator | Standard primary care. Receives: Procedure: Usual Care |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of Potentially Inappropriate Prescriptions (PIPs).
The primary outcome is the number of prescribed medications identified as one of the four targeted PIPs recommended by Choosing Wisely Canada and the Canadian DePrescribing Network (CaDeN).
Measured: 12 months
Secondary outcomes (3)
Patient perception of SPIDER
Qualitative methods (survey and interview) will be used to measure patients' perception of SPIDER. Patients' attitude toward polypharmacy and deprescribing will be measured using a survey adopted from Veterans Affairs Multi-dimensional Survey. Patients' experience with the process, symptoms, relationship with the care provider, empowerment and care coordination dimension will be measured using an interview.
Measured: 12 months
Care provider perception of SPIDER
Qualitative methods (survey and focus group) will be used to measure care providers' perception of SPIDER, including the dimensions of acceptability, implementation, adaptation, integration, practicality and efficacy.
Measured: 12 months
Cost-utility of SPIDER
The cost-utility of SPIDER will be measured as the incremental gain in quality of life (measured by EuroQol-5D) between the two arms in relation to intervention costs and by comparing the differences in investments and healthcare costs captured through EMR data and emergency room use and hospitalization.
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Sep 2018
- Study start26 Mar 2018
- Primary completion31 Mar 2027 (estimated)
- Study completion31 Mar 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (89)Papers the sponsor has linked to this study.
- Other trials for PolypharmacyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 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.
- Masking
- None (open label)
- Enrolment
- 104 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Toronto Practice Based Research Network
- Sponsor type
- University, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), University of Toronto, North York General Hospital, College of Family Physicians of Canada, University of Ottawa, University of Alberta, University of Calgary, University of Manitoba, Research Manitoba, Fonds de la Recherche en Santé du Québec, Université de Montréal, Nova Scotia Health Authority, Dalhousie University, Dalhousie Medical Research Foundation, Doctors Nova Scotia, Memorial University of Newfoundland, University of British Columbia
- Responsible party
- Sponsor
- Investigators
- Michelle Greiver, MD, Principal investigator, North York General Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03689049
- Sponsor's protocol ID
- KPG-156886
- Acronym
- SPIDER
- Status last verified
- Apr 2026
- First submitted
- 26 Sep 2018
- Last updated
- 6 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: This study uses some data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) for outcome measurement. A data dictionary is available from CPCSSN. While data sharing agreements prohibit CPCSSN from making the data publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at http://cpcssn.ca/research-resources/cpcssn-data-for-research/; researchers with additional questions can contact CPCSSN by using the link. Outcome data collected for this project can be made available to researchers upon request; a SPIDER study member will need to be part of the new work to ensure adequate interpretation of the data. The study protocol including statistical analysis plan and informed consent form will be publicly available.
Publications
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.
PubMed 3147235Berk 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.
PubMed 1483633Riley 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.
PubMed 17485760Blumenthal 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.
PubMed 10229250Rais 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.
PubMed 23968673Chang 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.
PubMed 27326548Hochman 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.
PubMed 28243870Berk 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.
PubMed 11260963Guilcher 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.
PubMed 26937955Tanuseputro 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.
PubMed 25811195Lavan 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.
PubMed 26834959Reeve 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.
PubMed 28456823Fletcher 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.
PubMed 19920442Tannenbaum 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.
PubMed 24733354Lindblad 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.
PubMed 16982290
Study at a glance
From the registry record, last updated by the sponsor on 6 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients
- ClinicalTrials.gov ID
- NCT03689049
- Acronym / sponsor ID
- SPIDER / KPG-156886
- Conditions
- Polypharmacy, Inappropriate Prescribing, Aged, Primary Health Care, Quality Improvement, Electronic Health Records
- Keywords
- Polypharmacy, Deprescribing, Aged Adult, Elderly Patient, Primary Health Care, Quality Improvement, Practice Facilitation, Learning Collaborative
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 104 participants (estimated)
- Lead sponsor
- University of Toronto Practice Based Research NetworkUniversity, hospital or other
- Collaborators
- Canadian Institutes of Health Research (CIHR), University of Toronto, North York General Hospital, College of Family Physicians of Canada, University of Ottawa, University of Alberta, University of Calgary, University of Manitoba, Research Manitoba, Fonds de la Recherche en Santé du Québec, Université de Montréal, Nova Scotia Health Authority, Dalhousie University, Dalhousie Medical Research Foundation, Doctors Nova Scotia, Memorial University of Newfoundland, University of British Columbia
- Study start
- 26 Mar 2018 (actual)
- Primary completion
- 31 Mar 2027 (estimated)
- Study completion
- 31 Mar 2027 (estimated)
- First posted
- 28 Sep 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- 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.
| Arm | Type | Receives |
|---|---|---|
| SPIDER | Experimental | Procedure: SPIDER, Procedure: Usual CareQI Learning Collaboratives. |
| Usual Care | Placebo comparator | Procedure: Usual CareStandard primary care. |
Who may qualify
- Ages
- 65 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Older adult
Key inclusion criteria (3 listed)
- 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.
- 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.
- 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.
Key exclusion criteria (6 listed)
- 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.
- 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.
- 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.
- PBRN: Practice Based Research Network;
- CPCSSN: the Canadian Primary Care Sentinel Surveillance Network)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| SPIDERThe 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. | Procedure or surgery | SPIDER |
| Usual CarePhysicians 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. | Procedure or surgery | SPIDER, Usual Care |
Primary outcome
Number of Potentially Inappropriate Prescriptions (PIPs).
Time frame: 12 months
The primary outcome is the number of prescribed medications identified as one of the four targeted PIPs recommended by Choosing Wisely Canada and the Canadian DePrescribing Network (CaDeN).
3 secondary outcomes
Patient perception of SPIDER
Time frame: 12 months
Care provider perception of SPIDER
Time frame: 12 months
Cost-utility of SPIDER
Time frame: 12 months
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 May 2026.
- Background: PubMed 3147235Berk 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.
- Background: PubMed 1483633Berk 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.
- Background: PubMed 17485760Riley 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.
- Background: PubMed 10229250Blumenthal 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.
- Background: PubMed 23968673Rais 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.
- Background: PubMed 27326548Chang 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.
- Background: PubMed 28243870Hochman 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.
- Background: PubMed 11260963Berk 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.
- Background: PubMed 26937955Guilcher 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.
- Background: PubMed 25811195Tanuseputro 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.
- Background: PubMed 26834959Lavan 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.
- Background: PubMed 28456823Reeve 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.
- Individual participant dataSharing planned: Yes. This study uses some data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) for outcome measurement. A data dictionary is available from CPCSSN. While data sharing agreements prohibit CPCSSN from making the data publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at http://cpcssn.ca/research-resources/cpcssn-data-for-research/; researchers with additional questions can contact CPCSSN by using the link. Outcome data collected for this project can be made available to researchers upon request; a SPIDER study member will need to be part of the new work to ensure adequate interpretation of the data. The study protocol including statistical analysis plan and informed consent form will be publicly available.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michelle Greiver, MD principal investigator
North York General Hospital
9 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing SPIDER in people with Polypharmacy and Inappropriate Prescribing, run by University of Toronto Practice Based Research Network at 9 sites in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 6 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 9 sites in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of Potentially Inappropriate Prescriptions (PIPs). (time frame: 12 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03689049, which also lists 89 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 May 2026.