Implementation of a collaborative project between primary and secondary care to minimize inappropriate polypharmacy in Donostialdea Integrated Health Care Organization

Abstract

Summary: A collaborative experience between primary care (PC) and secondary care (SC) has been designed and implemented in Donostialdea-Integrated Health Care Organization (IHO), with the aim to minimize inappropriate polypharmacy and improve patient safety. Intervention components are: communication and knowledge, shared training, consensus development, medication review, evaluation. Collaboration PS-SC is feasible and improves appropriate polypharmacy. Introduction: Polypharmacy and inappropriate polypharmacy increases the likelihood of adverse drug events, interactions, hospitalizations, contributes to non-adherence and higher costs. Donostialdea-IHO serves 360,000 citizens. One of the main barriers to stop potentially inappropriate prescriptions (PIP) in PC is the lack of agreement and collaboration across level. Short description of practice change implemented: Intervention components were: - Communication and knowledge between PC and SC professionals. - Shared training - Consensus development for selection and management of PIP criteria - Information technology to identify patients at risk - Medication review - Evaluation Aim and theory of change: We implemented a collaborative experience between PC-SC, with the aim to improve patient safety and minimize inappropriate polypharmacy. We adopted D'Amour's structuration model of collaboration and SYMPHATY polypharmacy management approach to design the intervention. Targeted population and stakeholders: Patients with = 5 prescriptions and at least one PIP criteria. Healthcare providers: pharmacists, PC physicians, SC physicians from traumatology, rheumatology, cardiology, neurology, respiratory medicine, gastroenterology, internal medicine. Promoters: interdisciplinary team (11 health professionals), leaded by PC pharmacists. Trainers and referents: 20 PC physicians and 7 SC physicians. Timeline: 2016: A series of meetings were carried out with professionals from PC and SC. 21 PIP criteria were selected, 6 consensus documents written, communication channels established. Shared training was implemented. Patients with PIP were identified using electronic health records. Their identification-codes were sent to PC physicians for evaluation. A controlled before-after study was carried out to evaluate the impact of the intervention in Donostialdea-IHO, with patients from Bilbao-Basurto-IHO as a control group. 2017: Feedback meetings were organized. 12 PIP criteria were selected and patient's codes were sent to PC physicians for evaluation. 2018: Patient's identification codes meeting previous PIP criteria and additional ones will be sent to physicians. Training sessions will be held. Highlights: 2016: The number of patients meeting PIP criteria in Donostialdea-IHO decreased from 15,570 to 13,094 (-15%). The control group did not experience statistical change (from 24,866 to 24,862). 2017: The number of patients meeting PIP criteria in Donostialdea- IHO decreased from 10,613 to 9,764 (-8.1%). Comments on sustainability: The effect knew a lesser magnitude on the second year. The involvement and insight of the medical staff was higher in PC. The intervention is feasible with the available resources. Comments on transferability: This practice has been adopted by other IHO in Osakidetza. Conclusions: Collaboration between PS and SC is feasible and can minimize inappropriate polypharmacy. Discussions: Polypharmacy management across levels is complex. It requires continuous participation, clinical and policy leadership, information system support and share training. Lessons learned: Future interventions should aim to consolidate the achieved changes and to increase the collaboration and involvement of medical staff and managers.