Polypharmacy and Adherence: Key Components of Integrated Care Findings from the SIMPATHY Project

Abstract

Context, aims and objectives : As many as half of all patients with chronic conditions are using their medicines in a way that is not fully effective, resulting in sub-optimal treatment and subsequent increases in hospitalisations and emergency department visits. High levels of inappropriate prescribing further compound this problem. These issues are especially germane to older patients. Safe and effective pharmacotherapy remains one of the greatest challenges in this population, where models of healthcare delivery lag behind the enormous growth in single disease focused pharmacotherapy. The implications for safe, efficient, effective and sustainable deployment of healthcare resources are significant from both a healthcare systems and societal perspective. Integrated care models have the potential to mitigate inappropriate polypharmacy, while simultaneously diminishing problems related to poor adherence. Project SIMPATHY addresses both of these issues by aiming to stimulate and support innovation throughout the European Union regarding the management of polypharmacy and adherence in the older patient. The SIMPATHY Consortium has completed case studies in eight EU countries, providing useful insights into how different health care systems address this challenge. This workshop will present these findings, using them as a basis for discussion on the practicalities of integrating new practices into existing workflow, highlighting the opportunities that an integrated care model can provide. Target participants : Policymakers, health system administrators, managers, clinicians Proposed structure and timing : What do we mean when we say polypharmacy? How does it apply to me? Alpana Mair; Deputy Chief Pharmaceutical Officer for Scotland, Healthcare Quality and Strategy Directorate, Scottish Government Health Department Medicines management should be a key component of integrated care, affecting nearly all providers in all settings, and is paramount in the older population. However, health care providers are often faced with problems related to inappropriate management of polypharmacy and poor adherence by patients. This presentation will introduce the audience to the concept of polypharmacy and adherence, its importance, and what tools and evidence already exist to create solutions. Looking at Europe: A diverse and emerging picture of polypharmacy Jennifer McIntosh; Research Scientist at Hospital Clinic Barcelona / FCRB Building on original research undertaken by the SIMPATHY Consortium, a picture of current policies around polypharmacy in Europe has emerged. The picture is complex, with multiple economic, social, and cultural factors explaining the development of these programmes. The details of this picture provide a strong foundation for the development of future policies for appropriate management of polypharmacy. This presentation will detail the findings of 8 European case studies, showcasing current approaches polypharmacy management. _(Important: The details of each case study will be presented in a set of 8 posters that will be submitted to the conference by each institution carying out the work)_ Scaling up polypharmacy management: The Scottish success story Alpana Mair; Deputy Chief Pharmaceutical Officer for Scotland, Healthcare Quality and Strategy Directorate, Scottish Government Health Department Implementing a new programme into existing practice is one of the most challenging aspects of creating integrated health care systems. The Scottish National Health Service has achieved this by successfully developing and implementing a comprehensive polypharmacy management policy throughout their healthcare system. This programme has become a model on an international level, and is currently a reference point for the development of European wide policies to address polypharmacy in the elderly. This presentation will describe the rationale that prompted the development of the Scottish programme, unique features of the programme including leveraging national level patient data to identify patients at risk for inappropriate polypharmacy, and management strategies that facilitated the integration of the programme into daily practice on a wide scale. Polypharmacy and teamwork: The Catalan multidisciplinary experience Carles Codina; Head of Pharmacy Department at Hospital Clinic Barcelona - Consorci Hospitalari de Vic Nuria Molist; physician at the Acute Geriatrician Unit Consorci Hospitalari de Vic - Hospital Santa Creu de Vic Introducing new practices requires champions, especially in complex institutions. Although multidisciplinary teams are becoming the functional decision making unit, their implementation requires support from multiple stakeholders. Pharmacists in particular have a central role to play on these teams in developing a new understanding about the importance of appropriate polypharmacy management. This presentation will describe the development and implementation of a patient centred multidisciplinary care team, highlighting the role both the pharmacy and geriatric medicine departments played in creating a successful and sustainable programme. Facilitated discussion Albert Alonso (moderator); Innovation Directorate at Hospital Clinic Barcelona This work has been supported by the SIMPATHY project, grant agreement number 663082, co-funded by the European Commission CHAFEA Health Program