Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments

ABSTRACT

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.

KEYWORDS:

• Aged
• inappropriate prescribing
• literature review
• organisational change
• polypharmacy
• SIMPATHY

Article highlights

• Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities

• While traditionally polypharmacy has been classified in terms of the number of medicines, there is now a change in emphasis from ‘inappropriate polypharmacy’ to ‘appropriate’ or ‘optimal polypharmacy’

• A critical review of current policies and guidelines on polypharmacy management people identified the Scottish Polypharmacy Guidance as scoring high of the AGREE II instrument (The Appraisal of Guidelines for REsearch & Evaluation)

• This guidance describes a 7 step process provides a standardised structure for medicines review

• SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly) aims to stimulate and support innovation across the European Union

This box summarizes key points contained in the article.

Acknowledgments

We acknowledge the input of Kite Innovation Europe Ltd. to all SIMPATHY activities and Vicki Elliot specifically from the Information and Statistics Division in the preparation of Figure 2.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This work has been supported by the SIMPATHY project, Grant Number [663082], co-funded by the European Commission CHAFEA Health Program, as well as financial resources for science in the years 2015-2017 granted for the realization of the international project co-financed by Polish Ministry of Science and Higher Education.