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A case study of polypharmacy management in nine European countries: implications for change management and implementation.

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F.; Kardas, Przemyslaw; Lewek, Pawel; Malva, Jo�o; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt


Jennifer McIntosh

Albert Alonso

Katie MacLure

Derek Stewart

Thomas Kempen

Alpana Mair

Margarida Castel-Branco

Carles Codina

Fernando Fernandez-Llimos

Glenda Fleming

Dimitra Gennimata

Ulrika Gillespie

Cathy Harrison

Maddalena Illario

Ulrike Junius-Walker

Christos F. Kampolis

Przemyslaw Kardas

Pawel Lewek

Jo�o Malva

Enrica Menditto

Claire Scullin

Birgitt Wiese


Background: - Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Methods: - Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework across cases. Results: - Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland and Uppsala) and included all care settings. There was agreement even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Conclusion: - Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.


MCINTOSH, J., ALONSO, A., MACLURE, K., STEWART, D., KEMPEN, T., MAIR, A., CASTEL-BRANCO, M., CODINA, C., FERNANDEZ-LLIMOS, F., FLEMING, G., GENNIMATA, D., GILLESPIE, U., HARRISON, C., ILLARIO, M., JUNIUS-WALKER, U., KAMPOLIS, C.F., KARDAS, P., LEWEK, P., MALVA, J., MENDITTO, E., SCULLIN, C., WIESE, B. 2018. A case study of polypharmacy management in nine European countries: implications for change management and implementation. PLoS ONE [online], 13(4), article number e0195232. Available from:

Journal Article Type Article
Acceptance Date Mar 8, 2018
Online Publication Date Apr 18, 2018
Publication Date Apr 18, 2018
Deposit Date May 1, 2018
Publicly Available Date May 1, 2018
Journal PLoS ONE
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 13
Issue 4
Article Number e0195232
Keywords Polypharmacy management; Change management; Implementation; Europe
Public URL