Edinburgh Napier University

  Background
Multiple chronic diseases in individuals increase the risk of inappropriate polypharmacy, an under recognised public health issue. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) aims to develop change management tools to help integrate the management of polypharmacy into existing care systems. The objective is to describe programmes addressing polypharmacy and adherence in a sample of European Union (EU) countries, learn from their development, and design change management tools to support implementation in the EU

Methods
Mixed-method case studies were conducted at 9 sites in 8 EU countries via a review of existing polypharmacy and adherence policies, key informant interviews with those involved in policy development and implementation and, focus groups of clinicians and managers to validate preliminary results. Recognised change management principles (Kotter) and normalization process theory (NPT) were used in analysis.

Results
Preliminary analysis identified a wide range of programmes ranging from nothing identified (Greece, Italy, Portugal) to small pilots (Poland, Germany) to those scaling up (Spain, Northern Ireland) and national programmes (Scotland, Sweden). All agreed polypharmacy management is important. Barriers to implementation in cases with no programme included lack of multidisciplinary team culture, lack of strategic vision, scarce resources, and limited monitoring capacity. Cases with developed programmes had a higher density of change management and NPT constructs. Common elements included local origins of programme, reallocation of resources, and a clear strategic vision. Policy implementation and lack of clear indicators were cited as continuing challenges.

Conclusions
EU policies addressing polypharmacy management vary widely. The identified processes for development and implementation will inform the development of change management tools to support integration of polypharmacy management in the EU.

Key messages:
* Polypharmacy management policies accounting for local culture and resources are needed, with a focus on creating monitoring systems and identifying standard indicators

*Applying change management principles to help address an organisation’s readiness for change is essential at onset and also as an iterative process to ensure implementation