This article by Frankie Macpherson was first published on healthandcare.scot.

A collaborative project developing medicines reviews, Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years (iSIMPATHY), has improved care for patients prescribed multiple medicines.

The Scottish government and NHS Scotland partnered with the Republic of Ireland’s Health Service Executive and the Northern Irish Health and Social Care Trust and Medicines Optimisation Centre (MOIC) to deliver the €3,520,671 three-year project.

After training 160 additional GPs, hospital doctors and pharmacists to undertake these comprehensive medicines reviews, the cross-border trial reveals the potential benefits for patients, the economy and the environment.

Prescribing multiple medicines can be problematic for patients, particularly if the increased risk of harm from interactions between drugs, or between drugs and diseases, outweighs the intended benefits.

Interim results show that the interventions used over the three-year project have potentially prevented major organ failure and adverse drug reactions.

The work developed by iSIMPATHY may also have helped avoid hospital admissions, with patients being moved to more appropriate medication.

Scotland’s Public Health Minister, Maree Todd, said she looks forward to learning from the full evaluation this coming June:

“This project looked at some of our most vulnerable patients taking more than five medications. The reviews have avoided adverse combinations of drugs and hospitalisations while also reducing prescriptions and drugs costs.

“We will know more when the full evaluation is published in June, we will work with partners to see how we can these improvements can be applied more widely, potentially saving lives and money.”

An insight into the results revealed that two standard interventions were undertaken during the review process related to patient education and medicine reconciliation – with around nine additional interventions, from drugs charges to monitoring, were made. Of these, 82% were reported to be 'clinically significant'.

The iSIMPATHY project reports that medicines reviews are also particularly cost-effective because immediate interventions can allow patients to come off medicines they no longer require, helping avoid medicines waste.

Following the launch of NHS Scotland’s Climate Emergency and Sustainability Strategy, the Royal Pharmaceutical Society (RPS) welcomed the strategy and called for more action on medicines waste.

The organisation’s Scottish director said education for patients and prescribers is essential, while restating RPS Scotland’s call for supportive infrastructure to deliver realistic medicine.

The iSIMPATHY medicines interaction project has been supported by around €3.5m since 2019, mainly through European Union funding as well as input from the three countries’ project partners.

The EU funding came as part of the INTERREG VA project, designed to enhance cross-border cooperation, promote reconciliation and create a more peaceful and prosperous society. This aims to address the economic and social problems which result from the existence of borders.

Northern Ireland Department of Health Chief Pharmaceutical Officer, Mrs Cathy Harrison said: 

“I’m pleased to see the impact on patients and service users who have taken part in iSIMPATHY who are at the heart of the project’s aim to ensure the best and most sustainable use of medicines.

“iSIMPATHY has achieved this through training pharmacists and other healthcare professionals to deliver medicine reviews and embed a shared approach to managing multiple medicines.  Northern Ireland has been delighted to collaborate with our partner regions to build on the success of previous projects dedicated to improving medicine safety.”

Another staff and costing benefit highlighted is the downstream effect, such as preventable admissions to hospital, primary and social care settings – which may reduce the workforce pressures and costs associated with admissions.

The Republic of Ireland’s Health Minister, Stephen Donnelly, said the partners and multidisciplinary teams were essential to good outcomes for patients in this joint project:

“Medicines are the most common healthcare intervention used within the health system, and the use of the right medicine for the right patient at the right time is central to this.

“In the delivery of this project, pharmacists were strategically and ideally placed as medicines experts within a multidisciplinary team framework working to maximise therapeutic outcomes for optimal patient benefit.”

Project funding is managed by the Special EU Programmes Body, whose CEO, Gina McIntyre praised the work of iSIMPATHY in emphasising the importance of cross-border cooperation in delivering efficient health services.

She said this plays a major role in delivering good health services in the border regions while addressing the challenges of “a constrained budget environment” and rising demand, adding:

“Health is an important precondition for economic growth, while also fostering social cohesion. I am delighted to see just how effective this project has been in improving the lives of people in the region.”

The final evaluation report and summary are currently in progress, set to be published in three months’ time, but the joint effort aimed to deliver 15,000 effective medicine reviews by the end of March 2023.