casestudy_catalonia.pdf catalonia_case_study.pdf The Spanish case study examined polypharmacy management in Catalonia. Two distinct models in different practice settings were identified: a government sponsored programme targeting complex chronic patients in primary care and an institutional network programme targeting older adults admitted to hospital, long-term care or nursing homes. The government sponsored model utilised a vertical approach to implementation, focusing primarily on patient safety and individual physician prescribing. The goal of this programme was to implement the programme in a standardized way throughout the entire primary care system. A major driver of this programme was the goals outlined in the Catalan Health Plan and the service contract between primary care centres and the government. In contrast, the institutional network model utilized a horizontal implementation strategy led by both clinicians and managers. The focus was on providing holistic patient-centred care via a multidisciplinary team, with polypharmacy management as one component. The goal was to create a scalable programme based on a small pilot. Key facilitators of this programme included a “culture of geriatrics” supporting the use of multidisciplinary teams and an institutional culture of innovation. These programmes illustrate how the challenges of polypharmacy can be addressed in different healthcare setting utilising different resources. Both programmes face challenges in effectively changing current practices to facilitate the full implementation and subsequent scale up.