Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review

Wimmer, Barbara C.; Cross, Amanda J.; Jokanovic, Natali; Wiese, Michael; George, Johnson; Johnell, Kristina; Diug, Basia; Bell, John

doi:10.1111/jgs.14682

Cited by 163 publications

(133 citation statements)

References 36 publications

(255 reference statements)

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“…However, we found more complex medication regimens were associated with fewer adherences in our sample of older African American Adults. A recent systematic review of studies that focused on clinical outcomes and medication regimen complexity in older adults reports that research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results [49]. This systematic review indicates that moderate-quality evidence from a few studies suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Non-adherence to medication regimens among older African-American adults

et al. 2017

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BackgroundDespite concerns about racial differences on adherence to prescribed medication rigimens among older adults, current information about nonadherence among underserved elderly African Americans with co-morbidities is limited. This study examines the association between adherence to drug regimens and an array of medication-related factors, including polypharmacy, medication regimen complexity, use of Potentially Inappropriate Medications (PIM), and knowledge about the therapeutic purpose and instructions of medication use.MethodsFour-hundred African Americans, aged 65 years and older, were recruited from South Los Angeles. Structured, face-to-face interviews and visual inspection of participants’ medications were conducted. From the medication container labels, information including strength of the drug, expiration date, instructions, and special warnings were recorded. The Medication Regimen Complexity Index (MRCI) was measured to quantify multiple features of drug regimen complexity. The Beers Criteria was used to measure the PIM use.ResultsParticipants reported taking an average of 5.7 prescription drugs. Over 56% could not identify the purpose of at least one of their medications. Only two-thirds knew dosage regimen of their medications. Thirty-five percent of participants indicated that they purposely had skipped taking at least one of their medications within last three days. Only 8% of participants admitted that they forgot to take their medications. The results of multivariate analysis showed that co-payment for drugs, memory deficits, MRCI, and medication-related knowledge were all associated with adherence to dosage regimen of medications. Participants with a higher level of knowledge about therapeutic purpose and knowledge about dosage regimen of their medications were seven times (CI: 4.2–10.8) more likely to adhere to frequency and dose of medications. Participants with a low complexity index were two times (CI: 1.1–3.9) more likely to adhere to the dosage regimen of their medications, compared with participants with high drug regimen complexity index.ConclusionsWhile other studies have documented that non-adherence remains an important issue among older adults, our study shows that for underserved elderly African Americans, these issues are particularly striking. A periodic comprehensive assessment of all medications that they use remains a critical initial step to identify medication related issues. Assessment of their disease and medication related knowledge (e.g., therapeutic purposes, side-effects, special instructions, etc.) and their ability to follow complicated medication regimens and modification of their drug regimens requires inter-professional collaboration.

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Section: Discussionmentioning

confidence: 99%

Non-adherence to medication regimens among older African-American adults

et al. 2017

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“…Patients with multiple comorbidities and polypharmacy have an increased risk of drug-drug interactions and adverse drug events (11). Furthermore, therapeutic and medication regimen complexity may decrease medication adherence (12,13). Patients may have trade-offs in adherence; in other words, they may choose to adhere to some post-AMI preventive therapies but not to others.…”

Section: Introductionmentioning

confidence: 99%

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Korhonen

Robinson

Annis

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND Angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some but not all therapies. OBJECTIVE We investigated the effect of trade-offs in adherence to ACEI/ARBs, beta-blockers, and statins on survival among older people after AMI. METHODS We identified 90,869 Medicare beneficiaries aged ≥65 who had prescription of ACEI/ARBs, beta-blockers and statins and survived ≥180 days after AMI hospitalization in 2008−2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. We used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1 or none of the therapies versus group adherent to all 3 therapies. RESULTS Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared to being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [95%CI]) for mortality were 1.12 (1.04 to 1.21) for being adherent to ACEI/ARBs and beta-blockers only, 0.98 (0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (1.10 to 1.25) beta-blockers and statins only, 1.19 (1.07 to 1.32) for ACEI/ARBs only, 1.32 (1.21 to 1.44) for beta-blockers only, 1.26 (1.15 to 1.38) statins only, and 1.65 (1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. CONCLUSIONS Patients adherent to ACEI/ARBs and statins only had similar mortality as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE/ARBs. Nonadherence to ACEI/ARBs and/or statins was associated with higher mortality.

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“…Complex regimens have been associated with undesirable health outcomes, such as hospitalization and medication non‐adherence . These outcomes can affect patient safety and treatment effectiveness, and increase the use of health resources .…”

Section: Introductionmentioning

confidence: 99%