Abstract
Introduction: Inappropriate polypharmacy and adherence impact adversely on both population health and quality of life and health system burden and costs. The EU-funded SIMPATHY project identified recommendations to manage polypharmacy in Europe, building on the implementation of a Scottish programme addressing inappropriate prescribing and prevent medication-related harm. iSIMPATHY ( implementing Stimulating innovation in the Management of Polypharmacy and Adherence Through the Years) sought to implement these SIMPATHY findings in Scotland, Northern Ireland and Ireland. The approach centred around patient partnership, “what matters to me” and shared decision making in medicines reviews. The project increased workforce capacity capability through training healthcare professionals.
Aims, Objectives, Theory or Methods. The project aimed to:
- Determine the feasibility of embedding a standardised approach to medicines review in Northern Ireland and Ireland and scaling up the Scottish work. Apply change management methodology and shared decision making as part of a person centred approach to pharmacist-led medicines use review delivery in multiple healthcare settings, with multidisciplinary team (MDT) collaboration.
- Ensure the most sustainable use of medicines by training healthcare professionals in polypharmacy, change management and delivering person-centred medicines reviews.
- Utilise and develop digital tools to facilitate service delivery and data management.
- Facilitate sustainability and spread through developing workforce capability and evidence base.
Highlights or Results or Key Findings:
The project was highly effective, welcomed by patients and MDT colleagues and demonstrated economic dominance across care settings and three jurisdictions.
- 6,481 patients engaged in reviews in primary care, secondary care, outpatient clinics and care homes.
- An average of 11 interventions were made per patient, with 82% classified as clinically significant and 4% potentially preventing major organ failure or similar. 94% of interventions were accepted.
- The average number of medications reduced from 12 to 11 and 92% of reviews resulted in more appropriate medication use.
- Patient reported outcome measures (PROMs) indicated improved understanding, adherence and reduced adverse effects.
- Economic evaluation identified a positive return on investment as well as a reduction in carbon footprint of both admissions and wastage of medicines.
- Training was delivered to over 180 healthcare professionals.
- Online recruitment, training, meetings, learning events, data entry and remote service delivery including video and phone reviews were effective and acceptable
Conclusions: The iSIMPATHY person-centred comprehensive medicines review model has been demonstrated to be acceptable and effective in a range of healthcare settings and systems. iSIMPATHY is transforming the approach to medicines optimisation in the three project jurisdictions. The approach is being incorporated into guidance and mainstream use, with project findings informing policy and business cases, where investment is required.
Implications for applicability/transferability, sustainability, and limitations:
- The approach recommended in SIMPATHY is transferable .
- The evidence produced supports robust policy development .
- Barriers such as competing priorities and workforce capacity must be addressed.
- Patient awareness and empowerment to be active participants in the review is crucial
- An implementation pack and accredited online training pack is available.