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The SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) consortium have explored how healthcare management programmes can be implemented to improve medication safety and prevent patient harm by addressing the appropriate use of multiple medications (polypharmacy). Fundamental to these programmes is the principle that providers work in partnership with patients to enable shared decision making regarding medication, which improves patient adherence and medicines related outcomes. This report sets out the case for prioritising working together now to address inappropriate medication use over the next decade, to ensure the quality, economic and political systems are put in place to improve medication safety for patients. There are encouraging signs of the increasing recognition of these challenges, and the timeliness of this report. In March 2017, the World Health Organisation (WHO) launched a global challenge to address medication safety, with polypharmacy as a flagship element. A special interest group will be launched by the International Foundation on Integrated Care in May 2017.

AbstractIntroductionThe availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH.DiscussionPrescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use.ConclusionsThe high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Purpose: To identify how physicians can help polypharmacy patients deal with their disease condition by focusing on the non-clinical factors of care processes. Therefore, this study aims to answer the following specific questions: (1) What are the causes of polypharmacy? (2) How do patients experience the consequences of polypharmacy? (3) How can the service coproduction concept help physicians manage and reduce polypharmacy? Methodology: We applied a qualitative exploratory study. Data were collected by in-depth interviews, and the material was analyzed considering three coproduction dimensions - knowledge, skills, and motivation. Main results: This research found that several non-clinical factors may cause polypharmacy and trigger problematic phenomena. Accordingly, several initiatives that add value for patients who are in polypharmacy were suggested. Academic contributions: This research increases the knowledge about the non-clinical polypharmacy factors and possible initiatives to mitigate this condition. It is also essential because there are few studies focused on this subject in developing countries like Brazil. Practical contributions: This study proposed several interventions that physicians can use to manage polypharmacy.

Medication is the most common form of intervention to prevent disease or slow disease progression, with guidelines for single diseases recommending evidence based drug treatments. There remains the mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individual adults with multiple morbidities. The resulting polypharmacy (use of multiple medicines) can be both appropriate and inappropriate and the key healthcare aim for individual patients is to ensure the on-going safe and effective use of their multiple medicines.NHS Scotland developed, designed and implemented national policy to consider the patient pathway and the flow of work needed to be undertaken in clinical practice to address appropriate management of Polypharmacy. Implementation across all 14 health boards serving a population of 5.5 million people in Scotland utilised Kotter's 8 steps[1] for implementation of change supported by clinical and policy leadership, economic data and clinical outcome data. NHS Scotland have provided leadership for a European work plan. SIMPATHY , Stimulating Innovation in Managment of Polypharmacy and Adherence in the Elderly, (www.simpathy.eu) has benchmarked European strategies to address polypharmacy and through in-depth case studies in 10 EU countries, is developing strategies and tools to support innovation in polypharmacy and adherence management across Europe.Synthesis of the findings from application of change management tools such as Kotter, PESTEL (Political, Economic, Social,Technological, Environmental and Legal) and SWOT ( Strenghts Weaknesses, Opportunities and Threats), together with the case studies serve to inform further innovation. Comparison was made to other EU countries, that had started to implement a programme.Work undertaken in the Scottish programme has been used to develop an economic tool that may be used by other countries to explore the economic benefits of a national polypharmacy management programme. Transferability of ...

Introduction: Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.

The Japanese government is seeking to establish a community health program for the management of polypharmacy in elderly patients. To explore a community-based screening strategy for polypharmacy, this study examined the extent to which certain chronic diseases are strongly associated with polypharmacy among community-dwelling elderly adults in Japan. We used anonymized health insurance claims data from all beneficiaries aged 75 years and older in Tokyo, who received outpatient care between May 2014 and August 2014. We obtained the data from the Tokyo Metropolitan Association of Medical Care Services for Older Senior Citizens. The insurance program universally covers all citizens aged 75 years or older. The data included 134 categories of prescribed drugs and seven chronic diseases: hypertension, dyslipidemia, insomnia, osteoarthritis, diabetes, dementia, and depression. Polypharmacy was defined as the prescription of at least five drugs during a 4-month period. We estimated age- and sex-adjusted odds ratio (OR) for each chronic disease, using multivariate logistic regression analysis. The prevalence of polypharmacy among the beneficiaries (n = 1,308,412) was 34.4%. The prevalence was the highest among octogenarians (37.8%), followed by that among those aged 75–79 years (32.0%), nonagenarians (27.9%), and centenarians (10.9%). We found that the highest OR of having polypharmacy was 4.98 for diabetes (p < 0.001), followed by 4.75 for depression (p < 0.001); the lowest OR was 1.65 for dementia (p < 0.001). These findings emphasize the importance of identifying individual diseases to screen for polypharmacy among community-dwelling elderly patients.

AbstractObjectiveWe examine the association between college education and the number of medications used/misused in the past year. We also consider the possibility of differential socioeconomic returns to health for racial/ethnic minorities.MethodsThe data come from the 2015–2019 National Survey on Drug Use and Health (n = 144,589).ResultsIn accordance with human capital theory, we found that, in the full sample and white subsample, college education was associated with lower levels of polypharmacy, even with adjustments for financial insecurity, health, and lifestyle. Consistent with the diminished return theory, we observed that college education was mostly unrelated to polypharmacy among black and Hispanic individuals. While health commodity theory was supported among Asians, health disparity theory was confirmed among individuals of other races and ethnicities.ConclusionThe most important implication of our study is that polypharmacy can be simultaneously structured by durable systems of social stratification, including education, race, and ethnicity.