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

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, Przemys?aw; Kempen, Thomas; Kinnear, Moira; Lewek, Pawel; Malva, Joao; McIntosh, Jennifer; Scullin, Claire; Wiese, Birgitt


Derek Stewart

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

Przemys?aw Kardas

Thomas Kempen

Moira Kinnear

Pawel Lewek

Joao Malva

Jennifer McIntosh

Claire Scullin

Birgitt Wiese


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.


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. and WIESE, B. 2017. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLOS one [online], 12(11), e0188348. Available from:

Journal Article Type Article
Acceptance Date Nov 6, 2017
Online Publication Date Nov 20, 2017
Publication Date Nov 20, 2017
Deposit Date Dec 19, 2017
Publicly Available Date Dec 19, 2017
Journal PLoS ONE
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 12
Issue 11
Article Number e0188348
Keywords Nursing research; Care; Multimorbidity; Population; Prevalence; Guidelines; Safety; Impact
Public URL


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