Publisher Information: Uppsala universitet, Klinisk farmakogenomik och osteoporos Uppsala universitet, Institutionen för farmaceutisk biovetenskap Departament de Recerca i Innovació, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain Departament de Recerca i Innovació, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland Effective prescribing and therapeutics, Health and social care directorate, Scottish Government, Edinburgh, Scotland Laboratory of Pharmacology and Pharmaceutical Care, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal Servei de Farmàcia, Hospital Clínic de Barcelona, Barcelona, Spain Institute for Medicines Research, Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal Pharmacy Department and Regional Medicines Optimisation Innovation Centre(MOIC) Northern Health and Social Care Trust, Antrim, Northern Ireland Department of Social and Education Policy, University of Peloponnese, Korinthos, Greece, eHealth Innovation Unit, 1st Regional Health Authority of Attica, Athens, Greece Department of Health, Belfast, Northern Ireland Federico II University Hospital, Naples, Italy Institute of General Practice, Hannover Medical School, Hannover, Germany Department of Social and Education Policy, University of Peloponnese, Korinthos, Greece, eHealth Innovation Unit, 1st Regional Health Authority of Attica, Athens, Greece Department of Family Medicine, Medical University of Lodz, Lodz, Poland Department of Family Medicine, Medical University of Lodz, Lodz, Poland Institute of Biomedical Imaging and Life Sciences (IBILI) and Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy Clinical & Practice Research Group, School of Pharmacy, Queen’s University, Belfast, Northern Ireland Institute of General Practice, Hannover Medical School, Hannover, Germany 2018
Added Details: McIntosh, Jennifer
Alonso, Albert
MacLure, Katie
Stewart, Derek
Kempen, Thomas
Mair, Alpana
Castel-Branco, Margarida
Codina, Carles
Fernandez-Llimos, Fernando
Fleming, Glenda
Gennimata, Dimitra
Gillespie, Ulrika
Harrison, Cathy
Illario, Maddalena
Junius-Walker, Ulrike
Kampolis, Christos F
Kardas, Przemyslaw
Lewek, Pawel
Malva, João
Menditto, Enrica
Scullin, Claire
Wiese, Birgitt
نبذة مختصرة : 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
Jennifer McIntosh and Albert Alonso contributed equally to this work.
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