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Reading: Sustainable Implementation of Polypharmacy reviews as part of integrated care at Scale


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Sustainable Implementation of Polypharmacy reviews as part of integrated care at Scale


Alpana Rajesh Mair ,

Scottish Government, GB
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Moira Kinnear,

NHS Lothian, GB
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Simon Hurding,

Scottish Government, GB
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Nils Micheal,

Scottish Government, GB
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Martin Wilson

NHS Highland, GB
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Medication is  the most common form of  intervention to prevent disease or slow disease progression, with guidelines for single diseases recommending  evidence based drug treatments. There remains the mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individual adults with multiple morbidities. The resulting polypharmacy (use of multiple medicines) can be both appropriate and inappropriate and the key healthcare aim for individual patients is to ensure the on-going safe and effective use of their multiple medicines.

NHS Scotland developed, designed  and implemented national policy to consider the patient pathway and the flow of work needed to be undertaken in clinical practice to address appropriate management of Polypharmacy.  Implementation across all 14 health boards serving a population of 5.5 million people in Scotland utilised Kotter’s 8 steps[1] for implementation of change supported by clinical and policy leadership, economic data and clinical outcome data. NHS Scotland have provided leadership for a European work plan. SIMPATHY , Stimulating Innovation in Managment of Polypharmacy and Adherence in the Elderly, ( has benchmarked European strategies to address polypharmacy and through in-depth case studies in 10 EU countries, is developing strategies and tools to support innovation in polypharmacy and adherence management across Europe.

Synthesis of the findings from application of change management tools such as Kotter, PESTEL (Political, Economic, Social,Technological, Environmental and Legal)  and SWOT ( Strenghts Weaknesses, Opportunities and Threats), together with the case studies serve to inform further innovation. Comparison was made to other EU countries, that had started to implement a programme..

Work undertaken in the Scottish programme has been used to develop an economic tool that may be used by other countries to explore the economic benefits of a national polypharmacy management programme. Transferability of innovation will be supported through publication of a reference book based on the findings of SIMPATHY.

Synthesis of findings confirmed that key principles of Kotter  influenced the successful  implementation of national policy for management of polypharmacy in Scotland.  It was identified that policy and clinical  leadership  were essential drivers along  with a policy change that supported implementation in the service together with contractual arrangements . Lessons learned from national policy implementation in Scotland  and from local programmes in other EU countries, including facilitators and barriers, together with key features of an economic tool will inform innovation of integrated care at a policy level.


1- Kotter, John P. Leading Change. United States: Harvard Business Review Press, 2012.

How to Cite: Mair AR, Kinnear M, Hurding S, Micheal N, Wilson M. Sustainable Implementation of Polypharmacy reviews as part of integrated care at Scale. International Journal of Integrated Care. 2017;17(5):A485. DOI:
Published on 17 Oct 2017.


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