title: Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments.
abstract: 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.
authors.affiliation: a School of Pharmacy and Life Sciences , Robert Gordon University, Aberdeen , Aberdeen AB10 7GJ , United Kingdom of Great Britain and Northern Ireland.
authors.forename: Derek
authors.initials: D
authors.lastname: Stewart
authors.affiliation: b Healthcare Quality and Strategy Directorate , The Scottish Government , Edinburgh , United Kingdom of Great Britain and Northern Ireland.
authors.forename: Alpana
authors.initials: A
authors.lastname: Mair
authors.affiliation: b Healthcare Quality and Strategy Directorate , The Scottish Government , Edinburgh , United Kingdom of Great Britain and Northern Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: Wilson
authors.affiliation: c Department of Family Medicine , Medical University of Lodz , Lodz , Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Kardas
authors.affiliation: c Department of Family Medicine , Medical University of Lodz , Lodz , Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Lewek
authors.affiliation: d Innovation Directorate , Fundacio Clinic per a la Recerca Biomedica , Barcelona , Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Alonso
authors.affiliation: d Innovation Directorate , Fundacio Clinic per a la Recerca Biomedica , Barcelona , Spain.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McIntosh
authors.affiliation: a School of Pharmacy and Life Sciences , Robert Gordon University, Aberdeen , Aberdeen AB10 7GJ , United Kingdom of Great Britain and Northern Ireland.
authors.forename: Katie
authors.initials: K
authors.lastname: MacLure
mesh_terms: D000368:Aged; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000517:prevention & control*; D005062:European Union; D019317:Evidence-Based Medicine; D006291:Health Policy; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D055118:Medication Adherence; D019338:Polypharmacy; D017410:Practice Guidelines as Topic
keywords: Aged; SIMPATHY; inappropriate prescribing; literature review; organisational change; polypharmacy