RT Journal Article SR Electronic T1 Safer prescribing and care for the elderly (SPACE): cluster randomised controlled trial in general practice JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP BJGPO.2021.0129 DO 10.3399/BJGPO.2021.0129 A1 Katharine Ann Wallis A1 Carolyn Raina Elley A1 Simon A. Moyes A1 Arier Lee A1 Joanna Frances Hikaka A1 Joanna Hikaka A1 Ngaire M. Kerse YR 2021 UL http://bjgpopen.org/content/early/2021/10/13/BJGPO.2021.0129.abstract AB Background Safer prescribing in general practice may help to decrease preventable adverse drug events (ADE) and related hospitalisations.Aim To test effect of SPACE on high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and/or antiplatelet medicines and related hospitalisations.Design & setting 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 general practitioner (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 Primary outcome was difference in high-risk prescribing of NSAIDs and/or antiplatelet medicines at 6 months; secondary outcomes included high-risk prescribing for gastrointestinal, renal or cardiac ADEs separately; 12-month outcomes; and related ADE hospitalisations.Results We recruited 39 practices with 205 GPs and 191,593 patients including 21,877 (11.4%) participants, 1,479 (6.8%) with 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 (OR: 0.99 (0.87, 1.13)) although SPACE improved more for gastrointestinal ADEs (0.81 (0.68, 0.96)). At 12 months, the control group improved more (OR: 1.29 (1.11, 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.