A case study of polypharmacy management in nine European countries: Implications for change management and implementation

Abstract

BackgroundMultimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained.MethodsChange management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases.ResultsPolypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation.ConclusionWithin the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists

“…The initial literature review, semi-structured interviews and focus group triangulation were part of the original SIMPATHY case study. 12 Agreement with specific findings was expressed throughout the focus group session, but some areas needed more detail. To address these areas, 3 additional interviews were conducted.…”

“…To get a better understanding, the Swedish case was adapted study after publication of the 8 SIMPATHY case studies 12 : the scope was changed from a national level (Sweden) to a regional level (Region Uppsala), and incomplete findings were supplemented with additional data. We therefore present the updated Swedish case study, which aimed to explore the events, actions and other factors that were involved in the implementation and sustainability of medication reviews in older patients by clinical pharmacists in Region Uppsala.…”

“…11 One of the key activities of SIMPATHY was the performance of case studies in 8 European countries: Germany, Greece, Italy, Poland, Portugal, Spain, Sweden and the United Kingdom (UK). 12 The aim of these case studies was to address what existed regarding polypharmacy management in the EU; why programmes were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. These questions were answered in each country through individual case studies of national or regional programmes.…”

“…Framework analysis across all cases found that polypharmacy management was not consistently addressed within the studied EU countries, but it provided examples of initiatives that could assist managers and policymakers in developing or scaling up programmes. 12 One of these examples was the case study in Sweden. In past decades, the focus of the Swedish government has been on the quality of care in older patients.…”

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“…Gleichzeitig soll die Darstellung auf Patientenebene die Umsetzung erleichtern, indem Abweichungen nicht mühsam selbst ermittelt werden müssen, sondern durch den Algorithmus vorgeschlagen werden. Grundsätzlich wird die medizinische Anwendung von IT-basierten Informationssystemen national und international mit großem Interesse verfolgt und kann auch hinsichtlich der besseren Verfügbarkeit von Daten und ihrer automatisierten Analyse klinisch nützlich sein (Dalton et al 2016, McIntosh et al, 2018.…”