Pharmacist-led medicines reviews in GP practice; The iSIMPATHY project

Written by Leon O’Hagan MPSI - Senior Pharmacist iSIMPATHY Project (Louth)

across the world. The WHO third Global Patient Safety Challenge, Medication Without Harm, aims to reduce severe avoidable medication-related harm by 50%, globally in the next 5 years.2 The WHO highlight three priority areas for action to reduce medicationrelated harm; polypharmacy, transitions of care and high-risk medicines. The iSIMPATHY medicines reviews address the risks associated with these three priority areas.

Impacts of Inappropriate Polypharmacy:

Inappropriate polypharmacy can have a substantial detrimental impact on patients, with avoidable harm and decreased quality of life.

Non-Adherence

• Estimates suggest that half of all medicines are not taken appropriately costing the EU 125 billion annually.7

Introduction/Summary iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) is a European project funded in the EU Interreg VA programme, and managed by the Special EU Programme Body, that involves a partnership between the HSE, the Scottish Government, and the Medicines Optimisation and Innovation Centre (MOIC) in Northern Ireland. iSIMPATHY pharmacists are delivering holistic person-centred medicines reviews, focussing on patient needs and wants, as well as addressing clinical and safety considerations. iSIMPATHY adopts the Scottish 7-Step methodology (figure 1), which facilitates shared decision making and improved understanding, in addition to optimising medicines to improve outcomes.1 The pharmacists liaise with the GPs and other healthcare professional who action the changes as appropriate.

Over the past two years, GPs in border counties and their patients have benefitted from a novel EUfunded project. iSIMPATHY delivers an interdisciplinary collaborative approach centred around pharmacist-led medicines reviews. Clinical pharmacists have joined 11 practices and have delivered holistic person-centred medicines reviews with over 2,200 patients with complex medication needs, with changes made in collaboration with the GP. The approach is highly effective at identifying and addressing the risks associated with complex polypharmacy, incorporating shared decision making and improving patient understanding and experience. The project has been welcomed by GPs. This article describes the initiative and outcomes of iSIMPATHY to date, including GP and patient experience.

What is iSIMPATHY?

The project has recruited and trained 5 senior clinical pharmacists, who work in 11 GP practices in counties Donegal, Sligo, Leitrim, Cavan, Monaghan and Louth.

Why review medicines?

Medication and its omission is a leading cause of avoidable harm

Over 250,000 adults in Ireland receive 10 or more prescribed medicines on a regular basis.3 The concept of ‘appropriate polypharmacy’ recognises that patients can benefit from multiple medications provided that prescribing is evidence based, safe and reflects patients’ clinical conditions and priorities.1

As polypharmacy increases, there is a greater risk of inappropriate polypharmacy.1 This occurs when the potential harm for one or more medication(s) outweigh potential benefits because:

• There is no evidence-based indication

• The therapeutic objectives are not being/likely to be achieved

• There is an unacceptable risk of ADRs

• Non-adherence is associated with increased healthcare utilisation.8

• Non-adherence to diabetes therapy is associated with an 80% increased risk of death.7

• The more empowered patients feel, the more motivated they will be to adhere to their medications and to manage their conditions.9

Medication-Related Harm

• Inappropriate polypharmacy is associated with a higher rate of GP and Emergency Department visits.3,10

• ADRs are responsible for 1 in 10 hospitalisations in OECD countries.7

• Medications with a greater risk of ADRs include antithrombotics, antihypertensives,analgesics, anti-diabetics and antipsychotics.11,12

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