A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

Derek Stewart (Corresponding Author), Kathrine Gibson Smith, Katie MacLure, Alpana Mair, Albert Alonso, Carles Codina, Antonio Cittadini, Fernando Fernandez-Llimos, Glenda Fleming, Dimitra Gennimata, Ulrika Gillespie, Cathy Harrison, Ulrike Junius-Walker, Przemysław Kardas, Thomas Kempen, Moira Kinnear, Pawel Lewek, Joao Malva, Jennifer McIntosh, Claire ScullinBirgitt Wiese

Research output: Contribution to journalArticle

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Abstract

Background
Inappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.

Methods
Forty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.

Results
Ninety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.

Conclusion
Consensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.
Original languageEnglish
Article numbere0188348
Number of pages17
JournalPloS ONE
Volume12
Issue number11
DOIs
Publication statusPublished - 20 Nov 2017

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Delphi Technique
Polypharmacy
European Union
Consensus
Legislation
health services
laws and regulations
medicine
wages and remuneration
Remuneration
Delivery of Health Care
e-mail
Electronic mail
Drug-Related Side Effects and Adverse Reactions
Drug Interactions
stakeholders
Medicine
drugs
Pharmaceutical Preparations

Cite this

A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. / Stewart, Derek (Corresponding Author); Gibson Smith, Kathrine; MacLure, Katie; Mair, Alpana; Alonso, Albert; Codina, Carles; Cittadini, Antonio; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Junius-Walker, Ulrike; Kardas, Przemysław; Kempen, Thomas; Kinnear, Moira ; Lewek, Pawel; Malva, Joao; McIntosh, Jennifer; Scullin, Claire; Wiese, Birgitt.

In: PloS ONE, Vol. 12, No. 11, e0188348, 20.11.2017.

Research output: Contribution to journalArticle

Stewart, D, Gibson Smith, K, MacLure, K, Mair, A, Alonso, A, Codina, C, Cittadini, A, Fernandez-Llimos, F, Fleming, G, Gennimata, D, Gillespie, U, Harrison, C, Junius-Walker, U, Kardas, P, Kempen, T, Kinnear, M, Lewek, P, Malva, J, McIntosh, J, Scullin, C & Wiese, B 2017, 'A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people', PloS ONE, vol. 12, no. 11, e0188348. https://doi.org/10.1371/journal.pone.0188348
Stewart, Derek ; Gibson Smith, Kathrine ; MacLure, Katie ; Mair, Alpana ; Alonso, Albert ; Codina, Carles ; Cittadini, Antonio ; Fernandez-Llimos, Fernando ; Fleming, Glenda ; Gennimata, Dimitra ; Gillespie, Ulrika ; Harrison, Cathy ; Junius-Walker, Ulrike ; Kardas, Przemysław ; Kempen, Thomas ; Kinnear, Moira ; Lewek, Pawel ; Malva, Joao ; McIntosh, Jennifer ; Scullin, Claire ; Wiese, Birgitt. / A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. In: PloS ONE. 2017 ; Vol. 12, No. 11.
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title = "A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people",
abstract = "BackgroundInappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.MethodsForty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80{\%} agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.ResultsNinety panel members were recruited (64.3{\%} of target), with high participation levels throughout the three Delphi rounds (91.1{\%}, 83.3{\%}, 72.2{\%}). During Round 1, consensus was obtained for 27/46 statements (58.7{\%}), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.ConclusionConsensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.",
author = "Derek Stewart and {Gibson Smith}, Kathrine and Katie MacLure and Alpana Mair and Albert Alonso and Carles Codina and Antonio Cittadini and Fernando Fernandez-Llimos and Glenda Fleming and Dimitra Gennimata and Ulrika Gillespie and Cathy Harrison and Ulrike Junius-Walker and Przemysław Kardas and Thomas Kempen and Moira Kinnear and Pawel Lewek and Joao Malva and Jennifer McIntosh and Claire Scullin and Birgitt Wiese",
note = "Data Availability: All data are presented in the manuscript. Funding: This work has been supported by the SIMPATHY project, grant agreement number 663082, co-funded by the European Commission CHAFEA Health Program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments The authors thank the following partners of the SIMPATHY project for their contribution: Enrica Menditto, Maddalena Illario, Salvatore Riegler (Azienda Ospedaliera Universitaria Federico II), Michael Scott (Medicines Optimisation Innovation Centre, Northern Ireland), Martin Wilson, Nils Michael, Morag Keith (Scottish Government), Mary Geitona, Theodore Vontesianos, Christos Kampolis, Theodoros Katsaras (University of Peloponnese, Greece). We also acknowledge the input of all expert panel members and Kite Innovation Europe Ltd",
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TY - JOUR

T1 - A modified Delphi study to obtain consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people

AU - Stewart, Derek

AU - Gibson Smith, Kathrine

AU - MacLure, Katie

AU - Mair, Alpana

AU - Alonso, Albert

AU - Codina, Carles

AU - Cittadini, Antonio

AU - Fernandez-Llimos, Fernando

AU - Fleming, Glenda

AU - Gennimata, Dimitra

AU - Gillespie, Ulrika

AU - Harrison, Cathy

AU - Junius-Walker, Ulrike

AU - Kardas, Przemysław

AU - Kempen, Thomas

AU - Kinnear, Moira

AU - Lewek, Pawel

AU - Malva, Joao

AU - McIntosh, Jennifer

AU - Scullin, Claire

AU - Wiese, Birgitt

N1 - Data Availability: All data are presented in the manuscript. Funding: This work has been supported by the SIMPATHY project, grant agreement number 663082, co-funded by the European Commission CHAFEA Health Program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments The authors thank the following partners of the SIMPATHY project for their contribution: Enrica Menditto, Maddalena Illario, Salvatore Riegler (Azienda Ospedaliera Universitaria Federico II), Michael Scott (Medicines Optimisation Innovation Centre, Northern Ireland), Martin Wilson, Nils Michael, Morag Keith (Scottish Government), Mary Geitona, Theodore Vontesianos, Christos Kampolis, Theodoros Katsaras (University of Peloponnese, Greece). We also acknowledge the input of all expert panel members and Kite Innovation Europe Ltd

PY - 2017/11/20

Y1 - 2017/11/20

N2 - BackgroundInappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.MethodsForty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.ResultsNinety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.ConclusionConsensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

AB - BackgroundInappropriate use of multiple medicines (inappropriate polypharmacy) is a major challenge in older people with consequences of increased prevalence and severity of adverse drug reactions and interactions, and reduced medicines adherence. The aim of this study was to determine the levels of consensus amongst key stakeholders in the European Union (EU) in relation to aspects of the management of polypharmacy in older people.MethodsForty-six statements were developed on aspects of healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement. Panel members were strategists (e.g. directors, leading clinicians and commissioners) from each of the 28 EU member states, with a target recruitment of five per member state. Three Delphi rounds were conducted via email, with panel members being provided with summative results and collated, anonymised comments at the commencement of Rounds 2 and 3.ResultsNinety panel members were recruited (64.3% of target), with high participation levels throughout the three Delphi rounds (91.1%, 83.3%, 72.2%). During Round 1, consensus was obtained for 27/46 statements (58.7%), with an additional two statements in Round 2 and none in Round 3. Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7). Analysis of free text comments indicated that the vision statements were too ambitious and not achievable by the specified timeframe of 2025.ConclusionConsensus was obtained amongst key EU strategists around many aspects of polypharmacy management in older people. Notably, no consensus was achieved in relation to statements relating to the need to alter legislation in areas of healthcare delivery, remuneration and practitioner scope of practice. While the vision for the EU by 2025 was considered rather ambitious, there is great potential and clear opportunity to advance polypharmacy management throughout the EU and beyond.

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DO - 10.1371/journal.pone.0188348

M3 - Article

VL - 12

JO - PloS ONE

JF - PloS ONE

SN - 1932-6203

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M1 - e0188348

ER -