The Structured Process Informed by Data, Evidence, and Research (SPIDER) approach is designed to support deprescribing in primary care for people in Canada aged 65 years and older experiencing polypharmacy (prescribed 10 or more medications in a calendar year), which is linked to higher health care costs and reduced quality of life. SPIDER uses electronic medical record data to generate feedback reports for primary care practitioners, provides coaching to facilitate practice transformation, and provides interprofessional learning collaboratives. The goal is to promote practice-based quality improvement (QI) activities, enhance QI capacity, and promote the exchange of ideas across practices.

SPIDER addresses the appropriate use of medications by deprescribing “potentially inappropriate prescriptions” (PIPs) in older patients living with polypharmacy. PIPs could increase the risk of adverse drug events. The current focus is on deprescribing for 4 priority medication classes: proton pump inhibitors, benzodiazepines and Z-drugs, antipsychotics, and sulfonylureas. These medications have been associated with risks such as sedation, falls, or metabolic disturbances.

The SPIDER approach is being evaluated through a cluster randomized controlled trial in primary care settings, aiming to improve medication safety and enhance the quality of care for older adults. The SPIDER approach is being compared to usual care in participating practices.

TaperMD technology is a structured clinical pathway with integrated decision support for reducing harmful polypharmacy. Developed and designed as an evidence-based technology supported pathway to address the known barriers to reducing polypharmacy, TaperMD is structured for 2-way integration with leading electronic medical records (EMRs), for example PointClickCare. TaperMD integrates:

Patient information and priorities: Physiological measures, relevant laboratory tests, patient treatment priorities and goals.

Individualized evidence screen: An automated evidence-based screen assesses all medications simultaneously, flagging potential problems. TaperMD’s unique visual presentation streamlines information to see-at-a-glance both cumulative side effect burdens and potentially problematic individual medicines. 

Pharmacist and prescriber review within a shared TaperMD space producing a recommendation for each medicine. Integration with the prescribing module enables seamless generation of required review report formats and prescribing changes. 


TAPER is designed for older adults who are community dwelling or in supported care. TaperMD will assist care facilities with reducing the overall number of medications and those directly associated with physical function and falls. Facility-wide data can be used to monitor priority areas, for example number of residents prescribed antipsychotic medications. TAPER directly links to supporting resources in priority areas (e.g., deprescribing antipsychotic medications) and evidence-based Tapering guidance.

The Prescribing Practices Program (PPP), established by the College of Physicians and Surgeons of Manitoba (CPSM), promotes safe and effective prescribing practices, focusing on high-risk medications and medication regimens, including controlled medications and polypharmacy. PPP uses an educational approach with registrants, emphasizing evidence-based decision-making, while balancing patient and public safety.

PPP has 4 main objectives: Promoting evidence-based prescribing by ensuring that physicians are guided by the latest scientific research and best practices; adopting a quality improvement approach that balances individual patient needs and wants with broader concerns for patient safety and public health; focusing on higher-risk prescribing practices, such as opioid prescribing, managing concurrent substance abuse, and polypharmacy; and implementing an educational strategy that employs case-based learning, academic detailing, audit and feedback programs, and individualized coaching.

The goal is to enhance registrants’ knowledge, skills, and clinical decision-making capacity. Ultimately, better prescribing practices reduce risk and improve patient outcomes. It also contributes to physician efficacy, practice satisfaction, and overall practitioner health.

The Foundation for Medical Practice Education is a not-for-profit national, bilingual continuing professional development program affiliated with McMaster University, delivering the Practice-Based Learning Program (PBLP). Operating for over 30 years, the program includes practising family physicians and nurse practitioners. Residency and nurse practitioner training programs across Canada also use their materials.

The program offers up-to-date, evidence-based content centred around real patient cases. Fourteen modules are produced annually and cover a wide variety of primary care issues, selected through a rigorous process involving input from PBLP members and facilitators and a review of recent literature and guidelines. Appropriate use as well as deimplementation are addressed.

Modules are available in online interactive, PDF, or paper formats. Participants can explore this information individually or in ongoing small groups. Groups of 4 to 10 family physicians typically meet for 1.5 to 2 hours monthly. Trained facilitators guide discussions, identify practice gaps, and help integrate new knowledge into practice. Practice reflection, emphasizing the application of new knowledge to enhance patient care, is facilitated by a practice reflection tool with implementation reviewed 4 to 12 weeks later. PBLP members can also engage in Practice Improvement Activities (PIAs), guided projects for quality improvement, supported by a Quality Improvement Coach.

Established in 1994 in the Faculty of Medicine at the University of British Columbia, the goal of the Therapeutics Initiative (TI) is to improve health outcomes of British Columbians. True to its motto, “Better prescribing. Better health,” the TI provides clinicians, policy-makers, and the public with independent, evidence-based, and practical information on appropriate drug prescribing and related health care interventions. To achieve these objectives, the TI conducts rigorous systematic reviews and critical assessments of the best available evidence on drug therapies and interventions, and conducts drug utilization and pharmacoepidemiology studies to evaluate the health impact of policy and educational interventions, as well as assessing drug safety.

The Therapeutics Letter summarizes TI reviews and assessments and is distributed across BC, and worldwide as part of the International Society of Drug Bulletins network. The Portrait audit-and-feedback program provides clinicians with personalized prescribing data and practice recommendations. The TI hosts an annual conference, educational sessions, and monthly webinars on a range of therapeutic topics and research methods.

Funds for the TI are provided by the BC Ministry of Health through a contributory agreement with UBC. Strict conflict of interest and disclosure policies ensure the TI’s work meets high ethical standards.