Understanding the work of the iSimpathy project
The iSimpathy project was a project that ran in Scotland, Northern Ireland, and border areas of the Republic of Ireland from October 2019 to March 2023. It built on the Simpathy project in Europe, and was funded by the EU to the tune of some 3 million euros. It aimed to transform the approach to polypharmacy taken in the three jurisdictions. The project operated across two main areas, medicines reviews and training for pharmacists, GPs and hospital doctors, and has produced an impressive range of resources for both patients and professionals.
1. The Seven Steps for Medicines Reviews
The seven steps for medicines reviews provides a structure for healthcare professionals carrying out medicines reviews. These are reviews by patient and professional of all the patient’s medications.
A review starts by asking the patient what matters to them in taking their medicines. It goes on to discuss whether the patient is taking the right medicines, whether any are now unnecessary because the problem has resolved, and whether the medicines are effective in solving the problem. It also considers whether there are any harmful side-effects. It then considers whether the medicines are cost-effective, and sets out a shared medicine plan.
This is important for two main reasons. The first is that it has provided a shared approach to polypharmacy that places patients at the center of decision-making. The second is that it has embedded medicines reviews into healthcare within the areas involved in the project. Using medicines reviews is extremely cost-effective, in both the short and long term, because they reduce over-prescribing, and improve the outcomes for patients.
2. Guidance on polypharmacy
Polypharmacy Guidance: Realistic Prescribing is now in its third edition. It was developed by the Scottish Government’s Polypharmacy Model of Care Group in 2018, building on work by the Simpathy project (a forerunner to iSimpathy that spent two years studying polypharmacy in Europe). The guidance sets out general principles about polypharmacy, including the seven steps for medicines reviews.
3. The Managing Multiple Medicines app and website
The Managing Multiple Medicines app and website are divided into two parts: one for healthcare professionals and one for patients and carers. The section for healthcare professionals provides quick and easy access to the national guidance on polypharmacy and realistic prescribing and sets out the seven steps. The section for patients and carers provides a toolkit to support self-management of medicines, and shared decision-making about medication. It is designed to help patients prepare for medicines reviews, and also follow up important issues after reviews.
Both the app and website were developed with extensive consultation with patients and carers, as well as professionals. The development process also considered how to involve and support people who were not confident using digital tools. The information on medicines within the app and website is drawn from nhs.uk, and us updated at least every 7 days.
4. Medicines ‘Sick Day’ guidance
The Medicines ‘Sick Day’ guidance was designed to help patients to understand what medicines they might need to stop taking temporarily if they are ill. The guidance sets out two circumstances: vomiting and diarrhea, and fever, sweats and shaking. It explains that patients should only start taking their medicines again when they are well, defined as 24 to 48 hours of eating and drinking normally. A click-through takes you to a list of medications, which is designed to be completed by a healthcare professional with the patient, and then given to the patient for future use.
5. Training for professionals
The project has also developed an accredited training course on polypharmacy that counts for CPD points. It is designed to ensure that healthcare professionals are equipped to carry out medicines reviews. It consists of three 45-minute modules that can be completed on demand. There are also webinars and additional content and input available if required.
6. Other resources for professionals
The iSimpathy project also produced several other useful guides and explainer videos for healthcare professionals. The animations included a useful explanation of the principle of the numbers needed to treat (a way to measure the cost-effectiveness of treatments), and another about the role of the pharmacist in medicines reviews.
7. Patient resources and information
The project also produced various other information leaflets and resources for patients. These included a leaflet about medicines reviews, and guidance on preparing for medicines reviews. This includes a video on how to complete the ‘Questions for my medicines review’ section of the Managing Multiple Medicines app.
