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8 results on '"Fernandez-Llimos, Fernando"'

6. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

Author

Stewart, Derek, primary, Gibson-Smith, Kathrine, additional, MacLure, Katie, additional, Mair, Alpana, additional, Alonso, Albert, additional, Codina, Carles, additional, Cittadini, Antonio, additional, Fernandez-Llimos, Fernando, additional, Fleming, Glenda, additional, Gennimata, Dimitra, additional, Gillespie, Ulrika, additional, Harrison, Cathy, additional, Junius-Walker, Ulrike, additional, Kardas, Przemysław, additional, Kempen, Thomas, additional, Kinnear, Moira, additional, Lewek, Pawel, additional, Malva, Joao, additional, McIntosh, Jennifer, additional, Scullin, Claire, additional, and Wiese, Birgitt, additional

Published
2017
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7. A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

Author

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, and Menditto, Enrica

Subjects
POLYPHARMACY, CHANGE management, DRUG marketing, TELECOMMUNICATION systems, HOSPITAL care
Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2018
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8. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

Author

Ulrika Gillespie, Jennifer McIntosh, Ulrike Junius-Walker, Moira Kinnear, Antonio Cittadini, Carles Codina, Alpana Mair, João O. Malva, Katie MacLure, Dimitra Gennimata, Kathrine Gibson-Smith, Albert Alonso, Birgitt Wiese, Claire Scullin, Glenda Fleming, Fernando Fernandez-Llimos, Derek Stewart, Cathy Harrison, Paweł Lewek, Thomas G. H. Kempen, Przemyslaw Kardas, Stewart, Derek, Gibson-Smith, Kathrine, Maclure, Katie, Mair, Alpana, Alonso, Albert, Codina, Carle, Cittadini, Antonio, Fernandez-Llimos, Fernando, Fleming, Glenda, Gennimata, Dimitra, Gillespie, Ulrika, Harrison, Cathy, Junius-Walker, Ulrike, Kardas, Przemysław, Kempen, Thoma, Kinnear, Moira, Lewek, Pawel, Malva, Joao, Mcintosh, Jennifer, Scullin, Claire, and Wiese, Birgitt

Subjects
Male, Gerontology, Delphi Technique, Economics, Health Care Providers, Delphi method, lcsh:Medicine, Social Sciences, 030204 cardiovascular system & hematology, Pharmacists, Geographical locations, Pharmaceutical Sciences, 0302 clinical medicine, Medicine and Health Sciences, Medicine, Medical Personnel, 030212 general & internal medicine, lcsh:Science, media_common, Allied Health Care Professionals, Aged, 80 and over, education.field_of_study, Multidisciplinary, Nursing research, Europe, Professions, Female, Research Article, Human, Consensus, Patients, Drug-Related Side Effects and Adverse Reactions, General Science & Technology, Population, MEDLINE, Consensu, macromolecular substances, Medication Adherence, 03 medical and health sciences, Health Economics, Nursing, Humans, media_common.cataloged_instance, European Union, European union, education, Aged, Polypharmacy, Health Care Policy, Biochemistry, Genetics and Molecular Biology (all), Health economics, business.industry, lcsh:R, Health Services Administration and Management, Farmaceutiska vetenskaper, Health Care, Agricultural and Biological Sciences (all), lcsh:Q, Population Groupings, People and places, Drug-Related Side Effects and Adverse Reaction, Older people, business, Delivery of Health Care
Abstract

© 2017 Stewart 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: Inappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people. Methods: Forty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3. Results: Ninety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025. Conclusion: Consensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

Published
2017

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