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PLoS One. 2018 Apr 18;13(4):e0195232. doi: 10.1371/journal.pone.0195232. eCollection 2018.

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

Author information

1
Departament de Recerca i Innovació, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain.
2
School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland.
3
Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
4
Effective prescribing and therapeutics, Health and social care directorate, Scottish Government, Edinburgh, Scotland.
5
Laboratory of Pharmacology and Pharmaceutical Care, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
6
Servei de Farmàcia, Hospital Clínic de Barcelona, Barcelona, Spain.
7
Institute for Medicines Research, Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
8
Pharmacy Department and Regional Medicines Optimisation Innovation Centre(MOIC) Northern Health and Social Care Trust, Antrim, Northern Ireland.
9
Department of Social and Education Policy, University of Peloponnese, Korinthos, Greece.
10
eHealth Innovation Unit, 1st Regional Health Authority of Attica, Athens, Greece.
11
Department of Health, Belfast, Northern Ireland.
12
Federico II University Hospital, Naples, Italy.
13
Institute of General Practice, Hannover Medical School, Hannover, Germany.
14
Department of Family Medicine, Medical University of Lodz, Lodz, Poland.
15
Institute of Biomedical Imaging and Life Sciences (IBILI) and Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
16
CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
17
Clinical & Practice Research Group, School of Pharmacy, Queen's University, Belfast, Northern Ireland.

Abstract

BACKGROUND:

Multimorbidity 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.

METHODS:

Change 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.

RESULTS:

Polypharmacy 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.

CONCLUSION:

Within 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.

PMID:
29668763
PMCID:
PMC5905890
DOI:
10.1371/journal.pone.0195232
[Indexed for MEDLINE]
Free PMC Article

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