iSIMPATHY- improving quality, safety and value for people taking multiple medicines
Populations are ageing and many people over the age of 50 years live with multiple long-term conditions and as a result take multiple medications (otherwise known as polypharmacy). Medication is the single most common healthcare intervention and generates the third highest cost of health expenditure. Studies suggest up to 17% of all unplanned hospital admissions are attributable to medicines related harm. The management of polypharmacy is a barometer for effective person centred and integrated care in practice.
I am delighted to have led iSIMPATHY, an award-winning EU funded cross border project shown to improve patient outcomes for people taking multiple medicines. Previously the SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) consortium explored how to improve medication safety and prevent patient harm by addressing the inappropriate use of multiple medications. Fundamental to the approach is the principle that health and care providers work in partnership with patients to enable shared decision-making regarding medication, which improves patient adherence and medicines related outcomes. The iSIMPATHY project built on this previous work, recognising that the increase in multiple long-term conditions and associated polypharmacy is not limited to the older person.
Running across Scotland, Northern Ireland and the border areas of the Republic of Ireland, iSIMPATHY delivered transformational change at scale through partnership working and sharing of expertise. Using a multidisciplinary collaborative approach centred around pharmacist-led medicines reviews, this innovative project ensured the best and most sustainable outcomes with medication use in people taking multiple medicines. Over three years the project trained over 160 additional GPs, hospital doctors and pharmacists to undertake comprehensive medicines reviews and delivered over 6,000 medicines reviews with patients.
The iSIMPATHY evaluation report, illustrates the effects of prioritising working together to address inappropriate medication use. The report highlights how the project improved patient safety, care and outcomes whilst delivering significant benefits to the wider healthcare system, including cost savings and reduction of waste.
Key findings of the report include:
✔ 82% of interventions were rated clinically significant, while 4% of interventions (968) potentially prevented major organ failure or adverse drug reactions of similar clinical importance
✔the appropriateness of medicines improved in 92% of reviews, with an average reduction of one medicine (from 12 to 11)
✔direct medicines cost savings of £13,100 and a potential total of £168,800 savings from avoided healthcare resource usage per 100 reviews
✔patients reported better understanding of their medicines, improved adherence and experienced less harm
✔an average of 7.4 Quality-Adjusted Life Years (QALY) were gained per 100 patients
The full report is available at isimpathy.eu/summary.
iSIMPATHY created a blueprint for undertaking medicines reviews with people taking multiple medicines. This blueprint has implications for integrated practice by multi-professional teams across a range of health and care settings. Work is already underway to embed the successful approach and use of Patient Reported Outcome Measures which gather views of persons receiving services. An accredited multidisciplinary training package for professionals undertaking comprehensive polypharmacy reviews is available on Turas. This training has been approved by the Royal College of Physicians (UK) for 3 external CPD credits.
The project findings will inform the forthcoming updated Polypharmacy Guidance in Scotland, to ensure value and sustainability in healthcare and person-centred care in line with the principles of Realistic Medicine. You can hear more about this guidance in an interactive workshop session at ICIC24. A collaboration between IFICs SIGs on Polypharmacy and Adherence and Ageing & Frailty, the session will explore diverse insights on current challenges and integrated approaches to optimising adherence to medicines, reducing harm and personalising treatment. Participants will consider practical actions that different professionals can take to optimise polypharmacy and reduce harm at key service touchpoints. They will also identify strategies to enhance communication and shared decision making around medication, particularly for people with communication, cognitive or sensory impairment.
First and foremost, the priority for polypharmacy management must be about the quality and safety of care. It is heartening to have compelling evidence from iSIMPATHY that better patient and system outcomes can be achieved within the economic resources available and enabled by technology and political support. Now it’s time to put that evidence into practice.
Alpana Mair, Co-Lead for IFICs SIG on Polypharmacy & Adherence
Head of Effective Prescribing and Therapeutics Division, Scottish Government
Associate Professor, Edinburgh Napier University
Scottish Quality,Safety & Improvement Fellow,
Senior Clinical Fellow University of Edinburgh