Case Study – Italy | SIMPATHY project


No official policy statements or regulatory guidelines on polypharmacy have been released to date by Italian Health Authorities. However, it should be acknowledged that the growing awareness of the problem has been documented by the release of observational studies on this issue by national study groups and scientific societies. Medication reviews, conducted by application of appropriateness criteria and computerized decision support systems are approaches designed to improve the quality of prescribing for older people. In order to implement such strategies, more focused training courses on multimorbidity and polytherapy management are mandatory within healthcare curricula. Furthermore, the integration to a multidisciplinary team (physicians, pharmacists, and nurses) may positively impact on: • Reducing the prescribers sense of fear to discontinue or substitute drugs prescribed by others; • reducing the drug therapy fragmentation among different specialists; • reducing costs; and, • improving adverse drug reaction detection and reporting. Lack of management programmes and/or working policies in Italy regarding polypharmacy prescription and adherence to drug therapy and management, particularly among older adults, stimulated the design of a pilot study aimed at providing an evidence-base of the current status of polypharmacy in Italy. Focusing on the Campania Region, and on Naples metropolitan area, data were obtained from a large tertiary care hospital (in particular from several Departments of Federico II University Hospital) representing the current protocol applied when prescribing for older patients with excessive polypharmacy. A multidisciplinary approach starting with identification of patients at risk of drug-related problems, followed by medication review over a period of time and the application of inappropriateness criteria, supported by computerized decision support and electronic prescribing systems, was embedded in the comprehensive geriatric assessment aiming to achieve the best-tailored pharmacotherapy for each patient.