Although many tools have been used to identify potentially inappropriate prescribing (e.g. Beers criteria, Laroche criteria and START STOPP criteria), they do not provide a structure to review patients and their medicines holistically. 

The iSIMPATHY project 

The Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years (iSIMPATHY) project was a three-and-a-half-year European Union (EU) funded project and managed by the Special EU Programme Body in Northern Ireland, Scotland and the Republic of Ireland. It ran from 20189 to 2023. 

The project aims were to ensure the most sustainable use of medicines for patients by training pharmacists and other healthcare professionals to deliver person-centred medicines reviews and embedding a shared decision-making approach to managing polypharmacy (the use of multiple medicines).

The iSIMPATHY project embedded a multidisciplinary collaborative approach to deliver pharmacist-led, person-centred medicines reviews using the 7-Steps methodology. 

Reviews were carried out in different settings including hospital in-patient, out-patient and GP practice settings. A total of 6,481 patients participated in iSIMPATHY medicines reviews. The average age of patients reviewed was 72 years and 53% were female. An average of six long-term conditions were recorded per patient. The project pharmacists made an average of 11 interventions per review which included patient education, medicines reconciliation, medication changes and monitoring.

Interventions made were graded for clinical significance, with 82% being classified as clinically significant and 968 (4%) potentially preventing major organ failure, adverse drug reactions or incidents of similar clinical importance. Ninety-four per cent of interventions recommended were accepted. The average number of medications reduced from 12 to 11, with 92% of the reviews resulting in more appropriate medication use, therefore decreasing the likelihood of medication-related harm. Inappropriate medications were stopped (i.e. deprescribed), reduced or altered to improve appropriateness

An analysis of the economic costs and benefits associated with polypharmacy reviews was undertaken as part of the iSIMPATHY project, with detail shown in Annex A. The analysis determined that, on average, 100 reviews:

• Cost £7,500 (€8,786) to deliver
• Result in £13,100 (€15,346) direct savings associated with medication changes
• Can be associated with £6,600 (€7,731) indirect savings from avoided adverse drug reaction-related hospital admissions (in-patient costs)
• Avoid an average of £168,800 (€197,800) in medical costs and are associated with a 7.4 QualityAjusted Life Year (QALY) gain.