Table 2.

Summary of emerging evidence that informed the evolution of OPTI-SCRIPT intervention into SPPiRE.

Emerging evidence that informed the evolution of OPTI-SCRIPT intervention into SPPiRE
Original research
Paper	Conclusion
OPTI-SCRIPT trial5	Web based medication review is effective in reducing PIP
OPTI-SCRIPT process evaluation12	Web guided medication review acceptable to GPs and patients Focusing on high risk and ‘clinically relevant’ PIP more acceptable to GPs
DQIP trial14	Alerts and informatics to facilitate GP medication review effective in reducing PIP
DQIP criteria19	Identified priorities for safety and quality in prescribing Developed validated monitoring criteria
Systematic reviews
Paper	Conclusion
Interventions for improving outcomes in multimorbidity7	More RCTs in the area of multimorbidity needed Targeting risk factors or specific functional difficulties may lead to better outcomes
Interventions to improve the appropriate use of polypharmacy for older people15	Interventions are effective in reducing PIP but impact on clinical and patient reported outcomes remains unclear
Interventions to Address Potentially Inappropriate Prescribing in Community-Dwelling Older Adults20	Multi-faceted approach more likely to effective Future interventions should consider incorporating patient priorities
Clinical guidelines
Guideline	Conclusions
SIGN Polypharmacy	Medication review should be offered to anyone in residential care, older patients and those on ≥10 medicines Consider unnecessary drug therapy Consider adherence and treatment burden
NICE Multimorbidity	Structured medication review should be offered to all people on ≥15 medicines Patient priorities should be assessed and care tailored accordingly Treatment burden should be addressed and minimised Consider treatments that can be stopped because of:  Limited benefit  Increased risk of adverse effects  Non pharmacological alternatives
NICE Medicines Optimisation	Structured medication review should be offered to anyone with polypharmacy (not defined), anyone with chronic conditions and older people Medication review should include an assessment of safety and appropriateness The need for monitoring should be reviewed
Review papers/new concepts
Paper	Conclusion
Treatment burden16,21	Important component to consider when providing care for patients with multimorbidity Polypharmacy is a common contributor to treatment burden
Deprescribing17,22,23	Defined as ‘the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes’ Both feasible and safe Should be considered at every prescription request GPs concerned about precipitating ADWE