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Shared decision making to address management of multimorbidity and polypharmacy in the iSIMPATHY project


Alpana Mair

Scotland, GB
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Introduction: iSIMPATHY ( implementing Stimulating innovation in the Management of Polypharmacy and Adherence Through the Years) builds on the findings of the EU project and the Scottish national implementation of a program to address inappropriate prescribing and prevent medication related Harm. The rise in the prevalence of multimorbidity  in ageing societies is one of the greatest challenges now faced by health services internationally . Most medical research, guidelines, and contractual agreements  are focused on the management of single disease states. In these patients, individually treating each condition inevitably leads to the use of multiple medications (polypharmacy), the risks and benefits of which are largely unproven and often unpredictable.

Aims, Objectives, Theory or Methods: To implement a polypharmacy and adherence program in Northern Ireland, Ireland and scale up the work in Scotland using change management methodology. 10000 patients will receive a patient centered  7 step polypharmacy by a pharmacist working in partnership with a GP or hospital doctor. Quality assurance of the reviews is assessed by development of new tool person centered Medication Appropriateness Index, PC-MAI. The likelihood of contact avoided with another healthcare profession or hospital admission was measures through EADON score providing economic evidence costs avoided. Patient feedback is also been collected through PROMS through a patient app to facilitate shared decision-making. 

Highlights or Results or Key Findings: Approximately 3000 reviews have been completed to date. The reviews are undertaken in primary care, secondary care, outpatient clinics and care homes. Patients had an average of 7 comorbidities and 8-11 interventions made per patient. The interventions using the EADON score were found to result in an improvement in the standard of care or prevents major organ failure or adverse reaction of similar importance. Polypharmacy Safety indicators are also addressed to prevent medication related harm, Where PROMS have been collected, there has been improvement post review from patients. The delivery model was adapted as a result of COVID 19 so that the training and learning events were delivered online. Reviews were also delivered using a mix of face-to-face, telephone and video consultation. This has been an important contribution to manage multimorbidity during the pandemic.  An accredited training program will enable scale up to other areas in the countries.

Conclusions: Implications for applicability/transferability, sustainability, and limitations

Research from iSIMPATHY shows that the model in Scotland  can be transferred to other countries using change management methodology and standardized training to undertake person centered reviews across the healthcare system . Model is cost effective, prevents medication harm and well accepted by doctors, patients policy makers and healthcare managers.

How to Cite: Mair A. Shared decision making to address management of multimorbidity and polypharmacy in the iSIMPATHY project. International Journal of Integrated Care. 2022;22(S3):482. DOI:
Published on 04 Nov 2022.


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