BackgroundInappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.MethodsForty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.ResultsNinety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.ConclusionConsensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

Many of the difficulties stroke patients have adhering to secondary prevention strategies are potentially preventable with tailored information provision and appropriate monitoring and follow-up by primary healthcare professionals. We have designed an intervention addressing the identified barriers to medicine taking, the impact of which is currently being measured in a randomised controlled trial of a pharmacist-led home-based clinical medication review in stroke patients.

A variety of endoscopic haemostatic techniques have enabled major advances in the management of not only bleeding peptic ulcers and bleeding varices, but also in a variety of bleeding lesions in the small intestine and in the colon. Indeed, the development and widespread implementation of endoscopic haemostasis has been one of the most important developments in clinical gastroenterology in the past two decades. An increasingly ageing cohort of patients with multiple co-morbidity are being treated and therefore improving the outcome of gastrointestinal bleeding continues to pose major challenges.

Overall methodological quality of the studies was poor. Although positive effects on adherence were reported further, rigorously conducted, studies are needed to inform the use of eMMDs.

This study aimed to evaluate the quality of prescribing of cardiovascular medication by a criterion-based approach with reference to national treatment guidelines for the care of patients with diabetes mellitus. Case notes and database records of diabetic outpatients (age range 15-75 years) managed in a secondary care clinic of a major teaching hospital were reviewed and 23 criteria in a previously evaluated tool were applied to determine adherence to guidelines.For the 214 study patients (57.5% male, 69.6% type 2 diabetes mellitus), mean (SD) age was 52.2 (16.3) years and mean (SD) BMI was 30.3 (6.6) kg/m 2 . Overall guideline adherence was 74.0% (95% CI: 71.2, 76.8). Excluding criteria that were only applicable to less than 10% of the total study group, the three criteria with the highest adherence were 'use of metformin in overweight patients ': 95.1% (91.0, 99.3), 'use of statin in primary prevention of CHD': 94.3% (88.8, 99.7) and 'use of aspirin in secondary prevention of CHD': 93.8% (85.4, 100). Similarly, the three criteria with the lowest adherence were 'achievement of target blood pressure in patients on antihypertensives': 43.4% (34.2, 52.5), 'use of aspirin in primary prevention of CHD': 51.2% (35.9, 66.5) and 'use of ACE inhibitor in patients with defined risk factors ': 54.8% (44.7, 65.0). Among the overall level of non-adherence (26.0% of total applicable criteria) the proportion of criteria in which non-adherence was

This version is available at https://strathprints.strath.ac.uk/58503/ Strathprints is designed to allow users to access the research output of the University of Strathclyde. Unless otherwise explicitly stated on the manuscript, Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Please check the manuscript for details of any other licences that may have been applied. You may not engage in further distribution of the material for any profitmaking activities or any commercial gain. You may freely distribute both the url (https://strathprints.strath.ac.uk/) and the content of this paper for research or private study, educational, or not-for-profit purposes without prior permission or charge.Any correspondence concerning this service should be sent to the Strathprints administrator: strathprints@strath.ac.ukThe Strathprints institutional repository (https://strathprints.strath.ac.uk) is a digital archive of University of Strathclyde research outputs. It has been developed to disseminate open access research outputs, expose data about those outputs, and enable the management and persistent access to Strathclyde's intellectual output. Title PageA pilot study to assess the practicality, acceptability and feasibility of a randomised controlled trial to evaluate the impact of a pharmacist complex intervention to stroke patients in their own homes. Abstract ObjectiveTo test the practicality, acceptability and feasibility of recruitment, data collection, blood pressure monitoring and pharmaceutical care processes, in order to inform the design of a definitive randomised controlled trial of a pharmacist complex intervention to stroke patients in their own homes. MethodsPatients with new stroke from acute, rehabilitation wards and a neurovascular clinic (NVC) were randomised to usual care or to an intervention group who received a home visit at 1, 3 and 6 months from a clinical pharmacist. Pharmaceutical Care comprised medication review, medicines and lifestyle advice, pharmaceutical care issue (PCI) resolution and supply of individualised patient information. A pharmaceutical care plan was sent to the General Practitioner and CommunityPharmacy. Blood pressure and lipids were measured for both groups at baseline and at 6 months. Questionnaires covering satisfaction, quality of life and medicine adherence were administered at 6 months. ResultsOf 430 potentially eligible patients, 30 inpatients and 10 NVC outpatients were recruited. Only 33/364 (9.1%) NVC outpatients had new stroke. Thirty five patients completed the study (intervention = 18, usual care = 17).Questionnaire completion rates were 91.4% and 84.4% respectively. Blood pressure and lipid measurement processes were unreliable. From 104 identified PCIs, 19/23 (83%) recommendations made to General Practitioners were accepted. 3 ConclusionsModifications to recruitment is required to include patients with TIA. Questionnaire response rates met criteria but completion rates did not which merits fur...

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