Optimizing medications and reducing polypharmacy through medication reviews

Results are now available for a 3.5-year pharmacist-led medication review project in Europe. The project, called iSIMPATHY (Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years), was funded by the European Union (EU) and managed by the Special EU Programme Body in Northern Ireland, Scotland and the Republic of Ireland. The project aimed to ensure the most sustainable use of medicines for patients by training pharmacists and other healthcare professionals to deliver person-centred medication reviews that included a shared decision-making approach to managing polypharmacy.1,2The iSIMPATHY project used a multidisciplinary collaborative approach to deliver pharmacist-led medication reviews using a seven-step process. A pharmacist training program was developed, which included the rationale for the seven-step approach, the importance of numbers needed to treat (NNT) in this context, as well as change methodology and the psychology of interacting with patients.2Seven-step Medication Review ProcessPharmacists can engage patients in the iSIMPATHY medication review process using the following seven steps:31. What matters to you?Your medicine review will look at what matters to you. What do you need your medicines to help you with, and are there any important aspects of your life that your medicines would stop you from enjoying?2. Right medicine?What medicines are you taking? Make sure you have a full list of all the medicines you take, including those that you have bought which might be herbal, prescribed or traditional remedies.3. Unnecessary medicine?Are there any you no longer need to take? For example has your pain resolved?4. Effective medicine?Are the medicines helping to control your symptoms so that you feel better? Or are they managing a condition such as high blood pressure?5. Harmful medicine?Are you having any side effects or are the medicines impacting your daily life?6. Cost-effective medicine?Is there a more cost-effective alternative that will still be just as effective or better for you?7. Agree and share medicine planCheck that you are happy and understand the treatment plan agreed upon at your review and that it supports what matters to you.iSIMPATHY project resultsMedication reviews were conducted in various settings including hospital inpatient, outpatient and general practitioner practices. A total of 6,481 patients participated in the iSIMPATHY medication reviews; patients averaged 72 years of age, had an average of six long-term conditions and 53% were female. Pharmacists made an average of 11 interventions per review; these involved patient education, medication reconciliation, medication changes and monitoring.2 Key findings from the project using the seven steps approach are summarized below:82% of interventions were classified as clinically significant968 (4%) of interventions potentially prevented major organ failure, adverse drug reactions or incidents of similar clinical importance 94% of interventions recommended were accepted the average number of medications was reduced from 12 to 1192% of the reviews resulted in more appropriate medication use, thereby decreasing the likelihood of medication-related harm inappropriate medications were stopped (deprescribed), reduced or altered to improve appropriatenessreductions in the number of medications and improvement of appropriateness is expected to minimize medication waste, which is important to achieving both climate and sustainability strategies patients reported large improvements in understanding, with over 90% reporting post-review that they fully understood their medications and potential problems with medicines, compared with 16% pre-review patient-reported side effects were reduced from 64% pre-review to 38% post-reviewimprovements were seen in some parameters of medication adherencepatients reported decreased pain, discomfort, anxiety and/or depression following the medication reviews, as well as improvements in their ability to perform usual activities.2An economic analysis determined that, on average, conducting 100 medication reviews cost £7,500 (~$12,780 Can) to deliver and resulted in £13,100 (~$22,325 Can) direct savings associated with medication changes. It also estimated that conducting 100 medication reviews resulted in £6,600 (~$11,250 Can) indirect savings from avoided adverse drug reaction-related hospital admissions (inpatient costs), avoided an average of £168,800 (~$287,680 Can) in medical costs, and resulted in a gain of 7.4 Quality Adjusted Life Years.2The iSIMPATHY model for conducting medication reviews is generally applicable in a range of healthcare settings and in different healthcare systems.2 Other jurisdictions interested in adopting this model can refer to an implementation package and accredited online training package.1 Other iSIMPATHY resources of particular value to pharmacists include: Medicines Sick Day Guidance; Polypharmacy–Manage Medicines App and Website; 7 Steps Approach to Medicine Reviews (an animation explaining the 7 steps approach and how it can be applied to a med review); The Role of the Pharmacist; and Numbers Needed to Treat (NNT). In a press release accompanying the publication of the iSIMPATHY project data, Alpana Mair, Head of Effective Prescribing and Therapeutics Division, Scottish Government commented that “It is heartening to have compelling evidence from iSIMPATHY that better patient and system outcomes can be achieved within the economic resources available and enabled by technology and political support. Now it’s time to put that evidence into practice.”4 References:iSIMPATHY. Ensuring the best medication outcomes for patients. (accessed February 22, 2024).iSIMPATHY. Evaluation report – executive summary. (accessed February 22, 2024).iSIMPATHY. Medicine reviews and the 7 steps approach. (accessed February 22, 2024).Mair A. iSIMPATHY- improving quality, safety and value for people taking multiple medicines. January 29, 2024. (accessed February 22, 2024).

Optimizing medications and reducing polypharmacy through medication reviews

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