Patient-Level Medication Regimen Complexity Across Populations With Chronic Disease

Libby, Anne M.; Fish, Douglas N.; Hosokawa, Patrick; Linnebur, Sunny A.; Metz, Kelli R.; Nair, Kavita V.; Saseen, Joseph J.; Griend, Joseph P. Vande; Vu, Sara P.; Hirsch, J. E.

doi:10.1016/j.clinthera.2013.02.019

Cited by 143 publications

(166 citation statements)

References 40 publications

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“…13 That method is the first step toward obtaining a better understanding of how the complexity of HAART regimens affects adherence and medical outcomes. Subsequently, Libby et al (2013) developed a medication regimen complexity index to estimate complexity for whole pharmacotherapy (HIV and non-HIV drugs). 14 Although the impact of regimen complexity, number of agents, and pill burden on medication adherence have been addressed in literature, most studies have focused on antiretroviral use and have failed to consider the impact of other medications or therapies.…”

Section: ■■ Methodsmentioning

confidence: 99%

“…Subsequently, Libby et al (2013) developed a medication regimen complexity index to estimate complexity for whole pharmacotherapy (HIV and non-HIV drugs). 14 Although the impact of regimen complexity, number of agents, and pill burden on medication adherence have been addressed in literature, most studies have focused on antiretroviral use and have failed to consider the impact of other medications or therapies. [15][16][17][18] A few recent studies have considered the use of specific classes of medications on HIV-infected were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification.…”

Section: ■■ Methodsmentioning

confidence: 99%

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Concurrent Use of Comedications Reduces Adherence to Antiretroviral Therapy Among HIV-Infected Patients

Cantudo-Cuenca¹,

Jiménez-Galán²,

González³

et al. 2014

JMCP

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BACKGROUND: The use of highly active antiretroviral therapy has significantly reduced morbidity and mortality, thus increasing life expectancy of human immunodeficiency virus (HIV)-infected individuals, transforming HIV into a chronic disease. Accordingly, there has been an increase in the number of comorbidities concomitantly present in these individuals and also an increased use of comedications, which may negatively impact antiretroviral therapy adherence. These factors can affect adherence to antiretroviral therapy. The role of the HIV clinical pharmacist is essential to achieve therapeutic objectives and enhance adherence.

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Section: ■■ Methodsmentioning

confidence: 99%

Section: ■■ Methodsmentioning

confidence: 99%

Concurrent Use of Comedications Reduces Adherence to Antiretroviral Therapy Among HIV-Infected Patients

Cantudo-Cuenca¹,

Jiménez-Galán²,

González³

et al. 2014

JMCP

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“…17 Taking into consideration the individual components of the MRCI score, it was seen that the dosing frequency (MRCI section B) contributed to the final score more than the other components. This is similar to reports from other studies.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] However, the studies differ with regard to the contribution of section A and C towards the final score. [15][16][17] We also assessed if gender was a factor that affected the number of drugs a patient received and if the MRCI score varied across genders. In the pediatric age group, the number of drugs prescribed and the MRCI score did not differ significantly between the genders.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to the observations from other studies in institutionalized elderly inpatients where female gender was associated with a higher MRCI score. [15][16][17][18] The difference is likely due to the different study setting and disease conditions studied. Our results showed a strong positive correlation between the number of drugs prescribed per prescription and the MRCI score.…”

Section: Discussionmentioning

confidence: 99%

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Complexity of Medication Regimen Prescribed on Hospital Discharge in Paediatric and Geriatric Patients with Psychiatric Disorder

Kamath

Hadigal³

et al. 2017

JYP

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Background: Prescribing multiple medications to a patient increases the complexity of the treatment regimen and, thereby, the chances of noncompliance and adverse effects. The phase of discharge from the hospital is a critical period wherein the patient and/or the caretakers have to assume the responsibility of taking/providing the medications as directed by the physician. The objective of this study is to assess the complexity of medication regimen prescribed on hospital discharge to pediatric and geriatric patients with psychiatric disorders using the Medication Regimen Complexity Index (MRCI) instrument. Method: A descriptive, case record based study was conducted. The complexity of the hospital discharge prescriptions in pediatric and geriatric psychiatry patients was measured using the Medication Regimen Complexity Index instrument. Results: Of the 90 discharge prescriptions studied, 40 belonged to pediatric age group. The median number of drugs that each patient received was two in the pediatric group and five in the geriatric group (p<0.001). The median MRCI score was significantly higher in the geriatric group (15.5) compared to the pediatric group (7.5) (p<0.001). Gender difference was seen with significantly higher scores in geriatric men. Conclusion: While polypharmacy is of concern across all age groups, our study showed that the medication regimen complexity in significantly higher in the geriatric age group. Special attention is required in case of geriatric patients to simplify their medication regimen at the time of hospital discharge in order to ensure better compliance.Key words: Age, Gender, Medication regimen complexity, Polypharmacy, Psychotropics. Key messages: 1.Medication regimen complexity index is significantly higher in geriatric patients with psychiatric morbidity. 2.Gender difference is seen in the medication regimen complexity. 3.Prescriptions with the same number of drugs can have different medication regimen complexity scores. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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Complexity of Medication Regimens for Children With Neurological Impairment

et al. 2021

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IMPORTANCE Parents of children with severe neurological impairment (SNI) manage complex medication regimens (CMRs) at home, and clinicians can help support parents and simplify CMRs.OBJECTIVE To measure the complexity and potentially modifiable aspects of CMRs using the Medication Regimen Complexity Index (MRCI) and to examine the association between MRCI scores and subsequent acute visits. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study was conducted between April 1, 2019, and December 31, 2020, at a single-center, large, hospital-based, complex care clinic.Participants were children with SNI aged 1 to 18 years and 5 or more prescribed medications. EXPOSURE Home medication regimen complexity was assessed using MRCI scores. The total MRCI score is composed of 3 subscores (dosage form, dose frequency, and specialized instructions). MAIN OUTCOMES AND MEASURESPatient-level counts of subscore characteristics and additional safety variables (total doses per day, high-alert medications, and potential drug-drug interactions) were analyzed by MRCI score groups (low, medium, and high score tertiles). Associations between MRCI score groups and acute visits were tested using Poisson regression, adjusted for age, complex chronic conditions, and recent health care use. RESULTSOf 123 patients, 73 (59.3%) were male with a median (interquartile range [IQR]) age of 9 (5-13) years. The median (IQR) MRCI scores were 46 (35-61 [range, 8-139]) overall, 29 (24-35) for the low MRCI group, 46 (42-50) for the medium MRCI group, and 69 (61-78) for the high MRCI group.The median (IQR) counts for the subscores were 6 (4-7) dosage forms per patient, 7 (5-9) dose frequencies per patient, and 5 (4-8) instructions per patient, with counts increasing significantly across higher MRCI groups. Similar trends occurred for total daily doses (median [IQR],[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] doses), high-alert medications (median [IQR], 3 [1-5] medications), and potential drug-drug interactions (median [IQR], 3 [0-6] interactions). Incidence rate ratios of 30-day acute visits were 1.26 times greater (95% CI, 0.57-2.78) in the medium MRCI group vs the low MRCI group and 2.42 times greater (95% CI, 1.10-5.35) in the high MRCI group vs the low MRCI group. CONCLUSIONS AND RELEVANCEHigher MRCI scores were associated with multiple dose frequencies, complicated by different dosage forms and instructions, and associated with subsequent acute visits. These findings suggest that clinical interventions to manage CMRs could target various aspects of these regimens, such as the simplification of dosing schedules.

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Patient-Level Medication Regimen Complexity Across Populations With Chronic Disease

Cited by 143 publications

References 40 publications

Concurrent Use of Comedications Reduces Adherence to Antiretroviral Therapy Among HIV-Infected Patients

Concurrent Use of Comedications Reduces Adherence to Antiretroviral Therapy Among HIV-Infected Patients

Complexity of Medication Regimen Prescribed on Hospital Discharge in Paediatric and Geriatric Patients with Psychiatric Disorder

Complexity of Medication Regimens for Children With Neurological Impairment

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