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

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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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