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PLoS One. 2017 Nov 20;12(11):e0188348. doi: 10.1371/journal.pone.0188348. eCollection 2017.

A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people.

Author information

School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, United Kingdom.
Effective Prescribing and Therapeutics, Health and Social Care Directorate, Scottish Government, Edinburgh, Scotland, United Kingdom.
Directorate of Research and Innovation, Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain.
Pharmacy Department, Hospital Clínic de Barcelona, Barcelona, Spain.
Department of Translational Medical Sciences, University Federico II, Naples, Italy.
Institute for Medicines Research (iMed.Ulisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.
Medicines Optimisation Innovation Centre, Northern Health & Social Care Trust, Belfast, Northern Ireland.
Department of Social and Educational Policy, University of Peloponnese, Corinthos, Greece.
Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
Department of Health Social Services and Public Safety, Belfast, Northern Ireland.
Institute for General Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
Department of Family Medicine, Medical University of Lodz, Lodz, Poland.
NHS Lothian Pharmacy Service, Western General Hospital, Edinburgh, Scotland, United Kingdom.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
School of Pharmacy, Queen's University, Belfast, Northern Ireland, United Kingdom.



Inappropriate 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.


Forty-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.


Ninety 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.


Consensus 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.

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