Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities

Abstract

Background:The complexity of a medication regimen is related to the multiple characteristics of the prescribed regimen and can negatively influence the health outcomes of patients.Objective:To propose cut-off points in the complexity of pharmacotherapy to distinguish between patients with low and high complexities seen in a primary health care (PHC) setting to enable prioritization of patient management.Methods:This is a cross-sectional study, which included 517 adult and elderly patients, analyzing different cut-off points to define the strata of low and high pharmacotherapy complexities based on percentiles of the population evaluated. Data collection began with the solicitation of prescriptions, followed by a questionnaire that was administered by an interviewer. The complexity of a medication regimen was estimated from the Medication Regimen Complexity Index (MRCI). High complexity pharmacotherapy scores were analyzed from patient profiles, the use of health services, and pharmacotherapy. The criteria for subject inclusion in the sample population were as follows: inhabitant of the area covered by the municipality, 18 years or older, and being prescribed at least one drug during the collection period. Exclusion criteria at the time of collection were the use of any medication whose prescription was not available. All medications were accessed through the Primary Healthcare Service (PHS).Results:The median total pharmacotherapy complexity score was 8.5. High MRCI scores were correlated with age, medications taken with in the Brazilian PHS, having at least one potential drug-related problem, receiving up to eight years of schooling, number of medications and polypharmacy (five or more medicines), number of medical conditions, number of medical appointments, and number of cardiovascular diseases and endocrine metabolic diseases. We suggest different complexity tracks according to age (e.g., adult or elderly) that consider the pharmacotherapy and population coverage characteristics as high complexity limits. For the elderly patients, the tracks were as follows: MRCI≥25.4, MRCI≥20.9, MRCI≥17.5, MRCI≥15.7, MRCI≥14.0, and MRCI≥13.0. For adult patients, the limits of high complexity were MRCI≥25.1; MRCI ≥ 23.8; MRCI≥21.0; MRCI≥17.0; MRCI≥16.5; and MRCI≥15.5.Conclusion:The medication regimen complexity is associated with the patient’s illness profile and problems with the use of drugs; therefore, the proposed scores can be useful in prioritizing patients for clinical care by pharmacists and other health professionals.

Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease

“…The present study found that being female was associated with higher complexity of medication regimens after adjustment for other variables, which supports previous findings . This may be related to a sex difference in the concern about one's own health or in the presenting of symptoms, which might influence the prescribing and diagnoses performed by physicians .…”

“…There is no maximum score as the total score increases continuously when adding dosage forms, dosing frequency or additional directions. Studies using the MRCI have found scores ranging from 8.5 to 28.3 in elderly patients and patients with CKD . The daily total pill burden was defined as the total number of all tablets or capsules taken by the patients on a daily basis, including as‐needed and over‐the‐counter medications.…”

Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care

“…This result corroborates the importance of using a validated tool, consisting of realms that evaluate different aspects of pharmacotherapy for the measurement of complexity . Thus, medication number alone is not sufficient to measure the level of difficulty of using a medication therapy . Pharmacotherapy with fewer medications, but with a high frequency of daily administration, might be more complex than a pharmacotherapy with a greater number of medications, all administered only once a day …”

“…Likewise, older people who use polypharmacy usually have therapies with more frequent daily administration of their medications and the need for additional information for administration. Therefore, there is an increased complexity of their pharmacotherapy . In contrast, there was no association between MRCI scores and medication adherence.…”

“…MRCI preliminary standardization was carried out with the prescriptions ( n = 227) of the total sample of older adults by means of an intragroup rule, from the determination of the percentiles of the tool’s total scores. In order to propose the categorization of complexity scores, we considered that 50% of individuals had a prescription with usual complexity scores . Therefore, P25 and P75 percentiles were chosen as category boundaries: low complexity as total MRCI ≤ P25; medium complexity as P25 < total MRCI ≤ P75; and high complexity as total MRCI > P75.…”