出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Polypharmacy and medication adherence in the older population are significant public health issues throughout the European Union (EU), and are critical issues in integrated care. SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) is a consortium of 10 organizations representing 8 EU countries with the goal of stimulating innovation around polypharmacy and adherence, ultimately providing the tools for EU policy makers to adopt new programmes addressing this issue into existing healthcare systems. Methods : A mixed-methods case study was performed to identify and characterize factors that influenced the development and implementation of Swedish policies on the management of polypharmacy in the elderly, specifically regarding medication reconciliation and review activities. Data extraction included a desk review of these policy documents and guidelines at national and regional (Uppsala County) level. To fill knowledge gaps from the desk review, four key informant interviews were conducted, highlighting the employed change management strategies. Interview transcriptions were coded using the Kotter’s Eight Step Change Model and the Normalization Process Theory (NPT). As a validation method, the findings from the desk review and interviews were presented to and discussed by a focus group consisting of six policymakers and clinicians, one of which was a key informant interviewee as well. Results :Both presence and absence of characteristics of change management were identified within all Kotter’s principles and NPT domains. Taking into account the focus group validation, we report the following key findings. Facilitators of change: - availability of data from national prescribing indicators and research showing the urgency to increase the quality of care for the elderly; - awareness of the problem among the public at national level and the political will to fund activities for improvement;
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