Polypharmacy Management by 2030: a patient safety challenge

Abstract

Executive Summary Inappropriate polypharmacy and medicines adherence in the elderly is one of the most significant public health challenges of the current age. This burden is set to increase as the population ages and more people suffer from multiple long term conditions. There remains a lack of evidence-based solutions, as both medical research and healthcare delivery models have focused on single disease interventions. This challenge, and the limited range of solutions, has significant implications for how healthcare resource is used to address inappropriate polypharmacy. However, with up to 11% of unplanned hospital admissions being attributable to harm from medicines, and over 70% of these being due to elderly patients on multiple medicines there are significant opportunities to reduce this burden by timely and effective interventions. The Institute of Medicine report, Responsible use of Medicines demonstrates that 0.3% of the global health budget could be saved by managing polypharmacy appropriately. The report identifies key areas of focus which include using risk stratification to identify vulnerable patients and a more collaborative role for pharmacists, physicians and patients. Facing the challenge of reducing patient harm, the European Union (EU) issued a public health call to identify, develop and implement innovative solutions that can be implemented at scale to address key problems. Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly (SIMPATHY) is one of the funded projects to deliver tools to implement polypharmacy management programmes throughout the EU in the context of quality, economic and political factors. The SIMPATHY case studies, benchmarking survey and literature review demonstrate that there are some effective polypharmacy management programmes in the EU, but that they are too few in number. The project also demonstrates that patients believe inappropriate polypharmacy is an important issue to address. This report calls for EU countries to work together in a focused way to manage and prevent inappropriate polypharmacy, and improve medicines adherence, through the use of a change management approach that is coordinated and collaborative in order to deliver better patient outcomes.

Six key recommendations:

1 - Use a systems approach that has multidisciplinary clinical and policy leadership. 2 - Nurture a culture that encourages and prioritises the safety and quality of prescribing. 3 - Ensure that patients are integral to the decisions made about their medications and are empowered and supported to do so. 4 - Use data to drive change 5 - Adopt an evidenced based approach with a bias towards action. 6 - Utilise, develop and share tools to support implementation.

Adopting these recommendations will help prepare EU countries for the WHO global challenge to improve medication safety, of which polypharmacy is an essential element.