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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.

Introduction: Medication review and polypharmacy management, especially in the elderly, are key components of integrated care. Although polypharmacy management is often associated with the primary care setting, hospital clinicians, who are often members of multidisciplinary therapeutic teams, have an opportunity to improve the management of polypharmacy, which has the potential to improve health outcomes in both hospital and primary care. Methods: Mixed-methods (desk reviews, key informant interviews and focus groups) case studies were carried out in Greece and Catalonia, in the framework of the SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) project, in order to describe policies and procedures on the management of polypharmacy and adherence in the elderly and describe implementation strategies. Kotter's Eight Step Process for transforming change and normalization process theory (NPT) were applied both in data collection tools and in the analysis. Progress report: At both sites there was awareness regarding the need for management of polypharmacy in the elderly, although in Greece awareness had not translated to a sense of urgency, a critical early step in Kotter's process. Barriers to implementation in Greece included extreme financial pressure, lack or organizational culture supporting multidisciplinary teams and shared decision making, and lack of guidance from central health authorities. However, despite the lack of national guidelines, hospital pharmacists in state (public) hospitals currently review medication for inpatients and out-patients, and interventions regarding inappropriate polypharmacy and reconciliation of care have been piloted. In Catalonia, implementation of an Institutional network sponsored model has been implemented and it is being evaluated. Polypharmacy was integrated as a specific component of a broader patientcentered service model, driven by a small multidisciplinary team, with a focus on global health outcomes. Facilitators, to implementation included an organizational culture of innovation and shared decision making, advanced training requirements of all hospital pharmacists, and regional health policies focusing on improved care for patients with complex chronic disease. Conclusion and future work: Although Greece is a country with no programme of polypharmacy management identified, there are some policies and clinical activities in place that could support future programmes. National guidance will ultimately be needed to mobilize health professionals and ensure consistency of care. The Catalan experience demonstrates that polypharmacy management can occur in the hospital setting. Future challenges include scaling the current model into other units within the hospital and into primary care. Given the pharmacist training and current medicines management activities in Greece, the hospital may be an appropriate entry point for polypharmacy management activities in that country, later scaling up to the community. As other health systems look to address polypharmacy, hospital should be considered a potential starting point for initiating a programme. Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union's Health Programme (2014-2020). [ABSTRACT FROM AUTHOR]

Introduction: Polypharmacy and medication adherence in the older population are significant public health issues throughout the European Union (EU), and are critical issues in integrated care. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) is a consortium of 10 organizations representing 8 EU countries with the goal of stimulating innovation around polypharmacy and adherence, ultimately providing the tools for EU policy makers to adopt new programs addressing this issue into existing healthcare systems. Methods: A mixed-methods case study is ongoing in Greece to identify policies on the management of polypharmacy and adherence issues in the elderly. A desk review of the polypharmacy and adherence policies at the government, regional and institutional level has been completed. Legislation, regulations, guidance and other policy documents from the National Organization for Healthcare Services Provision, the Direction of Pharmaceutical Policy of the Greek Ministry of Health, the 1st Regional Healthcare Authority (RHA) of Attica (about 5 million inhabitants), the public body which is responsible for electronic prescription at a national level and the National Organization of Medicines were analyzed. Key informant interviews will be conducted with policymakers and health professionals responsible for developing and implementing strategies. Focus groups consisting of policymakers, clinicians and patients will then be used to validate the research findings. Progress report: The desk review highlighted several surveys illustrating the extent of inappropriate polypharmacy in various settings and geographic areas of Greece, but did not recognize any type of national, regional or local policies, guidelines and legislation regarding polypharmacy and adherence. Currently, most prescribers use disease-specific guidelines (therapeutic protocols), and local initiatives lead by community pharmacists and/or other healthcare professionals address some aspects of, but do not constitute structured, comprehensive programs on polypharmacy management. Health spending in Greece has dropped in each of the years since 2009, driven by a sharp reduction in public spending as part of government-wide efforts to reduce the large budgetary deficit. Implementation of e-prescription at a national level contributed to the rationalization and modernization of medicine prescription and decreased pharmaceutical costs in the country, but did not directly address the issue of polypharmacy and medication adherence. Conclusion and future work: Results from key informant interviews and focus groups are expected to elucidate the possible constraints and barriers to conceptualization and implementation of polypharmacy programs in Greece. The results from this study combined with the other SIMPATHY case studies will provide valuable tools for policymakers, researchers, and clinicians throughout Europe as they move to integrate polypharmacy and adherence activities into existing health care systems. Funding: This poster is part of the SIMPATHY project (663082) which has received funding from the European Union's Health Programme (2014-2020). [ABSTRACT FROM AUTHOR]