Medication Regimen Complexity Index Prediction of Adverse Drug Reaction–Related Hospital Admissions

Curtain, Colin; Chang, Jie; Cousins, Justin; Nair, Nibu Parameswaran; Bereznicki, Bonnie; Bereznicki, Lre

doi:10.1177/1060028020919188

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…CMC regimens (e.g., medications, appointments) are inherently complex, leading to increased opportunities for errors. Research in adults has shown a link between number of medications taken and higher risk of hospitalizations 30 . Our findings suggest that clinicians should simplify regimens, although some aspects (e.g., total number of medications) may not be modifiable.…”

Section: Discussionmentioning

confidence: 73%

“…Research in adults has shown a link between number of medications taken and higher risk of hospitalizations. 30 Our findings suggest that clinicians should simplify regimens, although some aspects (e.g., total number of medications) may not be modifiable. Strategies to promote comprehension and adherence may instead lie with using the approaches discussed below.…”

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity

Glick,

Yin,

Silva

et al. 2024

Journal of Hospital Medicine

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BackgroundHigh rates of posthospitalization errors are observed in children with medical complexity (CMC). Poor parent comprehension of and adherence to complex discharge instructions can contribute to errors. Pediatrician views on common barriers and facilitators to parent comprehension and adherence are understudied.ObjectiveTo examine pediatrician perspectives on barriers and facilitators experienced by parents in comprehension of and adherence to inpatient discharge instructions for CMC.Design, Settings, and ParticipantsWe conducted a qualitative, descriptive study of attending pediatricians (n = 20) caring for CMC in inpatient settings (United States and Canada) and belonging to listservs for pediatric hospitalists/complex care providers. We used purposive/maximum variation sampling to ensure heterogeneity (e.g., hospital, region).Main Outcome and MeasuresA multidisciplinary team designed and piloted a semistructured interview guide with pediatricians who care for CMC. Team members conducted semistructured interviews via phone or video call. Interviews were audiorecorded and transcribed. We analyzed transcripts using content analysis; codes were derived a priori from a conceptual framework (based on the Pediatric Self‐Management Model) and a preliminary transcript analysis. We applied codes and identified emerging themes.ResultsPediatricians identified three themes as barriers and facilitators to discharge instruction comprehension and adherence: (1) regimen complexity, (2) access to the healthcare team (e.g., inpatient team, outpatient pediatrician, home nursing) and resources (e.g., medications, medical equipment), and (3) need for a family centered and health literacy‐informed approach to discharge planning and education. Next steps include the assessment of parent perspectives on barriers and facilitators to discharge instruction comprehension and adherence for prents of CMC and the development of intervention strategies.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 78%

Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity

Glick,

Yin,

Silva

et al. 2024

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…The MRCI is a 65-item instrument with different complexity levels which are based on weighted averages of the number of drugs, dosage frequency, administration instructions, and prescribed dosage forms. Although previous research shows that it is a good predictor of hospitalization, hospital readmission, and medication adherence 53 , recent reports have highlighted that the MRCI is a long and complex instrument that does not outperform patient medication counts to predict medication-related hospital admission 54 . The DBI, which also has been found to be associated with functioning outcomes in older adults 55 , is a more specific measure that captures overall exposure to medications with anticholinergic and sedative properties that implements the principle of dose response to determine the effect of medication exposure.…”

Section: Discussionmentioning

confidence: 99%

A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study

Carr

Federman

Dzahini

et al. 2021

Sci Rep

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Polypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: ‘High risk, long-term’ (Class 1), ‘Low risk, long-term’ (Class 2), ‘High risk, short-term’ (Class 3), and ‘High risk for drug interactions, medium-term, regular’ (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the ‘low risk’ class tended to be male, cohabitating, and reported fewer health conditions, compared to ‘high risk’ classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three ‘high risk’ classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.

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“…The increased vulnerability of patients with cancer to ADRs can be attributed to the complexity of their condition and treatments [18,19]. This is further complicated by factors such as comorbidities, particularly in elderly patients, and the absence of complete safety and risk data for newly developed drugs or those used in pediatric populations [18].…”

Section: Discussionmentioning

confidence: 99%

Pharmacovigilance Practices by Healthcare Providers in Oncology: A Cross-Sectional Study

Alkofide,

Almalag,

Alromaih

et al. 2024

Pharmaceuticals

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Investigating pharmacovigilance (PV) practices among oncology healthcare providers (HCPs) is crucial for patient safety in oncology settings. This study aimed to assess the awareness, attitudes, and practices towards PV and identify barriers to effective adverse drug reaction (ADR) reporting for HCPs working in oncology-related settings. Employing a cross-sectional survey design, we collected data from 65 HCPs, focusing on their experiences with ADR reporting, education on ADR management, and familiarity with PV protocols. The results showed that about half of the responders were pharmacists. Around 58.9% of the respondents reported ADRs internally, and 76.9% had received some form of ADR-related education. However, only 38.5% were aware of formal ADR review procedures. Methotrexate and paclitaxel emerged as the drugs most frequently associated with ADRs. The complexity of cancer treatments was among the common reasons for the low reporting of ADRs by the study participants. The findings highlight the need for enhanced PV education and standardized reporting mechanisms to improve oncology care. We conclude that reinforcing PV training and streamlining ADR-reporting processes are critical to optimizing patient outcomes and safety in oncology, advocating for targeted educational interventions and the development of unified PV guidelines.

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Medication Regimen Complexity Index Prediction of Adverse Drug Reaction–Related Hospital Admissions

Cited by 6 publications

References 22 publications

Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity

Pediatrician perspectives on barriers and facilitators to discharge instruction comprehension and adherence for parents of children with medical complexity

A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study

Pharmacovigilance Practices by Healthcare Providers in Oncology: A Cross-Sectional Study

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