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SIMPATHY Project Newsletter issue #05, April 2017
SIMPATHY Project Newsletter issue #05, April 2017
Dear SIMPATHY friends,
Inappropriate polypharmacy and medicines adherence is a significant public health challenge and the burden is set to increase with an ageing population and as more people suffer from multiple long term conditions. 50% of patients taking 4 or more medications do not take them as prescribed and 3-6% of hospital admissions globally are caused by inappropriate medication use. It has been reported that 0.3% of the global health budget could be saved by managing polypharmacy appropriately.
There is, therefore, an urgent need to achieve safe, sustainable, efficient approaches to the appropriate use of prescription medications. Last week at the Global Ministerial Summit in Bonn hosted by the German Health Minister, I provided the rationale as part of a WHO team as to why polypharmacy is a flagship area in the Third Patient Safety challenge that WHO is launching, “Medication Without Harm”. I believe that Europe should provide leadership in stepping up to this challenge of driving change to reducing harm from inappropriate polypharmacy as this is a global issue that also affects low and middle income countries.
The SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) project, co-funded by the third EU Health Programme, brings together ten partners from across Europe to address challenges in health service provision and sustainable management of medication among the elderly. The project aims to deliver the necessary change in management approaches and tools to help manage multi-medication and adherence to prescribed drugs. We would like to invite you to attend our final conference, where we will share the good practice identified; the components required to optimise impact and demonstrate new tools to gather evidence on the potential economic impact of improved approaches to polypharmacy. It is our hope that this conference will inspire you – as health leaders, professionals and key stakeholders – to adopt new approaches to improve outcomes for EU citizens from medicines and achieve efficiencies.
SIMPATHY High Level Conference
SIMPATHY is organizing a stakeholder conference which will take place in Brussels (Scotland House, Rond-Point Schuman 6), on April 27th, 2017. The conference will focus on most important outcomes and lessons of the SIMPATHY project, regarding healthcare management and leadership to tackle polypharmacy challenges and improve adherence to therapy, so that better health policies across Europe move forward. High level speakers, Members of the European Parliament and policy makers will come together to explore how the SIMPATHY project results can lead to better health policies across Europe to benefit patients, help health professionals, improve EU health strategy and contribute the sustainability of health systems .
The interactive event will explore opportunities for more European initiatives to improve the management of polypharmacy and support change across the EU. Participants will be also made aware of the European Commission’s DG Health and the WHO efforts to put this challenge into a European and global context. In addition, a most excellent thought leader from Harvard University will give a keynote address on the importance of leadership in healthcare change management. The conference is open for those interested. For more information on the programme, please visit our website (High Level Conference Brussels 27th April).
The adoption of adequate and sustainable polypharmacy management programs will contribute to better health outcomes in treatment of disease and will save financial resources for citizens and member states. For all these reasons and even more, an urgency to implement polypharmacy management policies across Europe becomes evident.
We look forward to meeting you, in Scotland House, Brussels, on 27 April 2017
SIMPATHY project aimed to identify and address the concerns and issues of different stakeholders towards shared purposes (for different stakeholders), shared values (behaviours) and shared results (to provide the necessary tension in the system to drive change).
Targeted communication with key stakeholders is at the heart of SIMPATHY, in order to embrace the full range of channels and mechanisms that underpin necessary change to the vision and the ability to respond to all stakeholders. Both EU policymakers and healthcare providers need to be involved to effectively address polypharmacy and improve adherence in complex chronic patients with multimorbidity.
Polypharmacy is a major challenge in the case of patients with chronic conditions and complex needs. The expansion of the “care team” should include multiple actors: patients, caregivers, community services, NGOs, managers, decision makers. In parallel, the type of health professionals and allied actors should also be expanded.
A Scottish patient’s viewpoint of the SIMPATHY project
We are all patients at some time in our lives. As we grow older, we are more likely to develop health problems which need long term, and perhaps multiple medications. As a patient, I want to know I’m getting the optimum effect from my medication. I don’t want to take unnecessary drugs either as that seems such a waste of public money – not to mention the environmental impact - and is, I feel, more likely to cause me additional health problems. My extended family and friends say the same. Ideally, I would want to have time with my GP or pharmacist to review what I take and why. I want to ask questions and get direct answers. I want to understand and take part in the decision making so I’m more likely to take my tablets. As a patient, appropriate polypharmacy makes sense to me and that’s why I support the aims of the SIMPATHY project.
by Dr. Katie MacLure
A clinician’s viewpoint of the SIMPATHY project
Polypharmacy is a term usually applied to a person that takes five or more medications. Albeit other definitions are also used, patients receiving polypharmacy always present some common traits: they tend to be older, with advanced fragility, suffering from multiple conditions and associated complexity. There is a clear consensus about the need to adopt a “patient-centred” approach when providing healthcare services to these patients. In this sense, the design of an individualised care plan is possibly one of the most relevant practical components of such approach. The challenge for health professionals is incorporating this “patient-centred” perspective when prescribing medicines.
In recent years, we have seen the emergence of a new approach to care that emphasises the optimisation of medicines and the adherence to treatment plans. Polypharmacy has been the focus of numerous studies that have resulted in the availability of new instruments that assist clinicians and pharmacist when prescribing. These instruments introduce new useful concepts such as "potentially inadequate prescription" or "deprescription" (discontinuing medications that are no longer indicated). Also, recent investigations have shown the urgent need for new approaches to interventions improving adherence as a necessary accompanying phase to the adequacy of prescription.
All these circumstances underline the importance of developing implementation strategies so that professionals can incorporate this new knowledge and skills in their usual clinical practice.
Project SIMPATHY will help us move in this direction. By providing practical advice on how a strategy on polypharmacy can be developed, deployed and scaled-up, it will be of great help for initiatives like our own. We will be taking into consideration many of the suggestions made by the project to further expand our “Patient-centred prescription” model, notably to help us in our current effort to work together with the primary care level.
by Dr. Joan Espaulella
A Policy Maker’s viewpoint of the SIMPATHY project
As a policy maker the SIMPATHY project has increased my awareness of the benefits of appropriate polypharmacy management and shown me that, although there is no single ‘one size fits all’ solution, lessons can be learned from the good practices being developed and implemented across Europe. These practices are demonstrating measurable safety and economic benefits which is highly relevant to Government policy in my country where medicines are the most common medical intervention used in the health service.
Polypharmacy is a growing problem related to population longevity, multimorbidity and increasing complexity of care. A current policy goal is to support reform and quality improvement in services to help people have the right number and combination of medicines throughout life for optimal health outcomes and minimised risk. This requires a whole system approach involving quality prescribing decisions, regular medication reviews and the involvement of patients and carers. Although health and social care services are adapting, introducing integrated models of care delivered by multi-professional teams, they need evidence based approaches to help deliver change and improve patient experience at pace. The SIMPATHY project will help support this by supporting communication and the sharing of experience, good practice and tools among stakeholders across European countries.
By Dr. Cathy Harrison
A higher educator viewpoint of the SIMPATHY project
As higher educators and researchers in health care area we are sure that medicines represent one of the most important milestones in the rise of life expectancy and healthy life expectancy. But we also learnt in the second half of the past century that inappropriate use of medicines can also be a public health issue. This double sided coin obliges educators to imbue in the future health care professionals the necessity of a judicious use of medicines. Polypharmacy is a perfect example of a situation where the professional has to reach the balance. We have to train professionals to use the therapeutic arsenal to improve patients’ health. But we have also to train professionals to be aware that adding up a new medicine in a patient’s therapeutic profile requires a further evaluation.
On top of this, we know that future health care professionals will be part of complex health care systems, with as many specialized providers as needed. Some of these professionals should perform the task of holistically review the whole patient’s therapeutic profile in a process that we called polypharmacy management. This task requires specific competences and teaching contents that we are obliged to introduce in University curricula. SIMPATHY project depicted a series of additional competences that might not be part of the curricula of many of the health care professional schools across Europe. Educators have to learn from SIMPATHY how to improve future professionals training to qualify them as polypharmacy managers.
by Dr. Fernando Llimos
A Health Economist viewpoint of the SIMPATHY project
Health economists help with achieving value for money by informing and improving decision-making about the allocation of scarce healthcare resources. Evidence on appropriate polypharmacy management is showing that this can be a policy intervention that is both clinically and cost-effective, helping to allocate today’s resources most efficiently and also helping to prevent avoidable future resource use.
For me, the SIMPATHY project has added to this evidence base on a European level, and, although there are country-specific differences in the approach and policy towards polypharmacy management, there has been evidence of the clinical and economic benefits throughout. The suite of change management tools in particular, including templates for PESTEL and SWOT analyses and an economic assessment tool, will be helpful to local decision makers across Europe in assessing what clinical and financial benefits appropriate polypharmacy management can bring to their area, helping them to shift the balance of health and social care towards prevention in the current climate of tight public spending.
by Dr. Nils Michael
A Researcher's viewpoint of the SIMPATHY project
Through the SIMPATHY project I have gained a broader understanding of the different scenarios in Europe, challenges and solutions, with regard to management of polypharmacy in elderly. This knowledge helps me make the research questions sharper and the studied interventions more feasible and applicable to different settings - generating clinically relevant positive outcomes in the patient population.
As researchers within the healthcare sector, we are often focussed on quantitative data regarding the effectiveness of our interventions. However, there is often a lack of understanding why certain interventions eventually do or do not work in clinical practice. Case studies within SIMPATHY and the SIMPATHY Reference Book provide clear examples of frameworks and theories, such as the Normalization Process Theory, which can be used for qualitative analyses. Such analyses can provide a deeper understanding of different components of the study interventions, for example the implementation, the mechanism of impact and the context, which is often needed to inform policy decisions and further integration of the interventions in daily practice.
by Dr. Ulrika Gillespie
SIMPATHY @ EIP-AHA annual conference
On December 5th – 8th SIMPATHY participated in the 2nd European Summit on Digital Innovation for Active and Healthy Ageing which took place in Brussels. SIMPATHY partners presented SIMPATHY project as a flagship project able to build unique synergies between A1, A3 and B3 actions groups in two thematic debates on Adherence to prescription (A1) and Integrated Care (B3), respectively “Better prescription and adherence to medical Plans for the ageing population” and “Tutoring and replicating integrated care for chronic diseases”.
SIMPATHY @ 8th Conference and Expo "Pharmacy & Medical Management & Communication"
SIMPATHY project was included in the presentation of "Polypharmacy management in the eldery. The reality in Europe", during the 1st Conference on PharmaceuticalCare, organised by The Hellenic Pharmaceutical Society (http://www.efe.org.gr/), in the framework of the 8th Conference and Expo "Pharmacy & Medical Management & Communication", in Athens, 18-19 February 2017 (http://www.pharmamanage.gr/en/events/811-8th-conference-expo-athens,-18-19-02-2017). The conference was attended by primary care physicians and community pharmacists. Delegates were informed on various aspects of polypharmacy management programmes in Europe and participated in a short discussion regarding the future of such programmes in Greece. Main outcomes of the SIMPATHY project, presented by Dr Dimitra Gennimata, have offered adequate "food for thought".
SIMPATHY @ Lodz Consortium Meeting
SIMPATHY consortium meeting took place in Lodz, Poland, March 27-28, 2017.
Partners revised the last activities, reports and deliverables produced by the consortium and planned key future actives. Priority activities include the organization of the High-Level Conference in Brussels (April 27, 2017) and the publication of the Reference Book “Polypharmacy Management by 2030: a patient safety challenge”
Scientific contribution by SIMPATHY members
Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines, with each discrete section denoting a single dosing occasion. While there is lack of robust research of effectiveness of MCAs improving medicines adherence, these are widely used and often heralded as a solution for non-intentional non-adherence. Patients, carers and health and social care professionals are largely supportive of their use, although there is an acknowledged need for a systematic approach to MCA provision and monitoring. One major drawback to the use of MCAs is there is often absence of a polypharmacy medicines review prior to use hence they may perpetuate potentially inappropriate medicines (PIM) use. This could have the consequence of improving adherence to unsuitable medicines.
A group of researchers in Scotland, including a member of the SIMPATHY team, has very recently published a study of MCA use in 2060 patients (59% female, median age 82 years [interquartile range: 70–87]). Patients were prescribed a mean of 7.4 distinct medicines per prescription (SD: 3.4, range 1–23), of which a mean of 6.4 were dispensed into the MCA (SD: 2.8, range 1–21). A total of 1977 PIMs were identified affecting 57.8% of patients. with at least one PIM occurring in 57.8% (1190) of the cohort, two or more in 25.1% (518) and three or more in 7.5% (154). The most frequent PIMs were potentially clinically significant drug-drug interactions (43.1%), ten or more distinct medicines (25.1%) and medicines with anticholinergic activity (16.6%). The authors concluded that there is a need for a more aggressive multidisciplinary approach to the review of the medicines prescribed to MCA users.
Prof. Derek Stewart
School of Pharmacy and Life Sciences
Robert Gordon University
SIMPATHY Handbook with most important outcomes and lessons on how to implement programmes addressing polypharmacy management to improve Patients’ safety will be released very soon. Do not miss! File will be available for download on our website. Stay tuned.
On 2016 two scientific publications of SIMPATHY were released. The first scientific paper on “Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments”, published at Expert Opinion on Drug Safety (Vol 16, 2017 – Issue 2) and the editorial on “Polypharmacy management programmes: the SIMPATHY Project” for the European Journal of Hospital Pharmacy (Vol 24 No 1, 2017). Both publications are available for download on our website (SIMPATHY Publications).
Take a look at the upcoming events of SIMPATHY. Maybe you will find us in a city near you! We will be happy to meet you there.
· 29th April - 2nd May 2017: 14th National Rural Health Conference (Cairns, Australia).
· 8th May - 10th May 2017: ICIC 17 - 17th International Conference on Integrated Care (Dublin, Ireland).
· 21st May - 24th May 2017: 6th FIP Pharmaceutical Sciences World Congress 2017 (Stockholm, Sweden).