PRP039: Baseline characteristics of older patients with complex multimorbidity recruited to the SPPiRE trial.
Caroline McCarthy, MB BCh; Emma Wallace, MD, PhD; Fiona Boland; Frank Moriarty, PhD, BPharm
Context: Providing evidence based care for patients with complex multimorbidity is challenging given their heterogeneity and that they are frequently excluded from clinical trials, however recruitment in this population has particular difficulties. Objectives: To describe patient uptake rates for the SPPiRE trial and to describe baseline characteristics of this population. Design: This descriptive study uses data from an on-going cluster randomised trial that is assessing the effectiveness of a web guided medication review in reducing polypharmacy and potentially inappropriate prescribing in older patients with multimorbidity (SPPIRE trial). Patient recruitment rates and baseline characteristics are presented using descriptive statistics. Dataset: Quantitative data collected for the purpose of the trial’s CONSORT participant flow and patient characteristics including demographics and patient reported outcome measures (PROMs) obtained from baseline patient questionnaires. Participants: 404 patients aged ≥ 65 years and prescribed ≥ 15 repeat medicines were recruited from 51 different general practices around Ireland. Results: Between April 2017 and December 2019, 3,113 patients from 74 practices were identified by running a patient finder tool; 1,790 of these were deemed eligible to participate giving an eligibility fraction of 57.5%. Exclusion criteria were nursing home residents and those cognitively unable to participate. Of the 1790 eligible patients, 404 were recruited and randomised, giving an enrolment fraction of 22.6%. Fifty-two patients from 23 different practices were excluded prior to randomisation as these practices failed to recruit enough participants. The mean age of recruited patients was 76.5 years (SD 6.8 years) and 58.4% were female. Twenty-two percent of patients reported seeing their GP at least once per month. A sizeable proportion reported health related quality of life (EQ-5D) scores in the severe or extreme impairment domains; for mobility (27%), activities of daily living (25%) and pain (29%). The median score on a multimorbidity treatment burden questionnaire was 16 (IQR 8) representing a medium treatment burden. Conclusion: Recruitment involved significant time input from recruited GPs and study personnel. Almost a third of practices were ultimately excluded as they failed to recruit a sufficient number of patients. Baseline data suggests that recruited patients have a significant disease and treatment burden.