“This is the single most important change in our practice since we were established over 20 years ago,” according to Donegal-based GP Dr Majella Grealish, commenting on iSIMPATHY, a HSE cross-border project reviewing patients’ use of multiple medicines (polypharmacy).

The project has improved the safety of patients by reducing adverse drug reactions. The Evaluation Report for the iSIMPATHY project found that 77% of interventions by HSE clinical pharmacists led to improved patient care, while 4% of interventions prevented major organ failure or serious adverse reactions. It also found that over €1.2m had been realised in savings due to fewer adverse drug reactions and admissions to hospital.

Ciara Kirke, Clinical Lead of the HSE’s National Medication Safety Programme and HSE iSIMPATHY project lead, explained that “over 2,500 comprehensive medicines reviews were carried out by pharmacists in GP practices in border counties as part of the iSIMPATHY project."

"This work resulted in people taking fewer and more appropriate medicines. An average of 11.4 interventions were made per patient, including drug changes and education, leading to a reduction of 1.2 medicines per patient.”

Patients reported significant improvements in their understanding of their medicines, increased ability to engage in daily activities and reduced side effects, following the reviews. Bernadette from Co Cavan said it was  “the best thing to come into my life in a while. It is absolutely great. I was floundering as I was on so many medications and I was lost.”

The collaborative project between health services in Ireland, Northern Ireland and Scotland saw pharmacists working within multidisciplinary teams and engaging with healthcare professionals across care settings. In Ireland, pharmacists and GPs worked in partnership with patients to enable shared decision-making regarding medication and improve outcomes.

Welcoming the report findings and positive outcomes for patients, Bernard Gloster, HSE CEO, said he was “pleased to see the impact on patients and service users who have taken part in iSIMPATHY."

"This project has played a major role in the delivery of effective and efficient health services in the border regions. It addresses the challenges we face with polypharmacy, improving care and safety for people with multiple long-term conditions. I am delighted to see just how effective this project has been in making a difference in the lives of people in the region.”

Dr Colm Henry, HSE Chief Clinical Officer, added that “the HSE is committed to addressing the risks of polypharmacy, which particularly affect our older population."

"The iSIMPATHY model of medicines review improved safety and outcomes, with reduced side effects and improved quality of life. We are exploring the potential to build on the benefits seen with iSIMPATHY through the expansion of the service.”  

Minister for Health, Stephen Donnelly noted that “medicines are the most common healthcare intervention, 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. I’d like to thank all the partners involved in the iSIMPATHY project for their work to achieve this.”

The World Health Organization (WHO) has recognised polypharmacy as a priority area for patient safety. Taking multiple medicines can be problematic if they are not achieving their intended benefits, or if the risk of harm outweighs the intended benefits. Many of these medicines are appropriate at the time of prescribing, and may be prescribed by different healthcare professionals (GP or consultant). A review at a later time that takes all factors into consideration may identify that it’s not as beneficial.

Over 8.6 million unplanned hospital admissions across Europe each year are due to adverse drug events, of which approximately 50% are potentially preventable.

The project received the Health and Wellbeing Causeway Award, celebrating collaboration between Scotland, Northern Ireland and Ireland, in October 2023.