A case study of polypharmacy management in nine European countries: Implications for change management and implementation

McIntosh, J; Alonso, A; MacLure, K; Stewart, D; Kempen, T; Mair, A; Castel-Branco, M; Codina, C; Fernandez-Llimos, F; Fleming, G; Gennimata, D; Gillespie, U; Harrison, C; Illario, M; Junius-Walker, U; Kampolis, CF; Kardas, P; Lewek, P; Malva, J; Menditto, E; Scullin, C; Wiese, B

A case study of polypharmacy management in nine European countries: Implications for change management and implementation

McIntosh, J Alonso, A MacLure, K Stewart, D Kempen, T Mair, A Castel-Branco, M Codina, C Fernandez-Llimos, F

Fleming, G Gennimata, D Gillespie, U Harrison, C Illario, M Junius-Walker, U Kampolis, CF Kardas, P Lewek, P Malva, J Menditto, E Scullin, C Wiese, B

Permalink

Publication Type:: Journal Article
Citation:: PLoS ONE, 2018, 13 (4)
Issue Date:: 2018-04-01

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Accepted Manuscript VersionAdobe PDF (2.4 MB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	McIntosh, J	en_US
dc.contributor.author	Alonso, A	en_US
dc.contributor.author	MacLure, K	en_US
dc.contributor.author	Stewart, D	en_US
dc.contributor.author	Kempen, T	en_US
dc.contributor.author	Mair, A	en_US
dc.contributor.author	Castel-Branco, M	en_US
dc.contributor.author	Codina, C	en_US
dc.contributor.author	Fernandez-Llimos, F https://orcid.org/0000-0002-8529-9595	en_US
dc.contributor.author	Fleming, G	en_US
dc.contributor.author	Gennimata, D	en_US
dc.contributor.author	Gillespie, U	en_US
dc.contributor.author	Harrison, C	en_US
dc.contributor.author	Illario, M	en_US
dc.contributor.author	Junius-Walker, U	en_US
dc.contributor.author	Kampolis, CF	en_US
dc.contributor.author	Kardas, P	en_US
dc.contributor.author	Lewek, P	en_US
dc.contributor.author	Malva, J	en_US
dc.contributor.author	Menditto, E	en_US
dc.contributor.author	Scullin, C	en_US
dc.contributor.author	Wiese, B	en_US
dc.date.available	2018-03-08	en_US
dc.date.issued	2018-04-01	en_US
dc.identifier.citation	PLoS ONE, 2018, 13 (4)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/130904
dc.description.abstract	© 2018 McIntosh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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 highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.	en_US
dc.relation.ispartof	PLoS ONE	en_US
dc.relation.isbasedon	10.1371/journal.pone.0195232	en_US
dc.subject.classification	General Science & Technology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Polypharmacy	en_US
dc.subject.mesh	Disease Management	en_US
dc.subject.mesh	Europe	en_US
dc.title	A case study of polypharmacy management in nine European countries: Implications for change management and implementation	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	13	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	13	en_US

Abstract:

© 2018 McIntosh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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 highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/130904