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Abstract
Different scales have been validated to assess the medication regimen complexity. However, the effect of this complexity on the risk of health care center consultations in patients with drug-related problems is unknown. This study’s objective is to evaluate the association between the Medication Regimen Complexity Index (MCRI) and the number of drugs prescribed and new consultations to the health care system in patients who visit an emergency service due to drug-related problems. This is a retrospective observational study. We included patients >65 years who attended in an emergency service for drug-related problems. To identify variables associated with health care center reconsultation, a multivariate analysis was performed, including demographic and comorbidity variables, number of drugs prescribed, and MCRI value. Two hundred and one patients were included. A significant association was found between the prescription of more than five drugs (odds ratio [OR] = 2.50, 95% confidence interval [CI] = [1.08, 5.79]), an MCRI > 20 (2.98 [1.46–6.09]), and an increase in the number of drugs prescribed (2.87 [1.57–5.21]) and its MCRI (2.06 [1.13–3.77]) at discharge and a new visit to the emergency department. An association was found between the prescription of more than five drugs, an MCRI > 20, an increase in the number of drugs, and in MCRI value at discharge and a new visit to any other health care center. The number of prescribed drugs and the medication complexity of patients who visit the emergency department for drug-related problems was associated with an increase in the number of revisits to the emergency department and to other health care centers.
Highlights
Over the last 40 years, developed countries have experienced a progressive aging of their population, with an increase in the number of patients with multiple chronic conditions and, the number of patients receiving multiple medications (Colchero et al, 2016; Salive, 2013).It is known that multiple medications are associated with an increase in hospital admissions and visits to emergency departments, as well as an increase in costs for the health system (Burnier, 2017; Gellad et al, 2011; Peterson et al, 2003; Simpson et al, 2006)
An increase in the number of drugs prescribed at discharge was observed in 82 (38.6%) patients, as well as an increase in their Medication Regimen Complexity Index (MCRI) in 106 (52.8%) patients, with a significant overall increase being observed in the group of patients included, 21.5 (13.1) versus 24.3 (14.3), p =
According to the results of this study, the increase in the number of drugs, as well as in the therapeutic complexity of those patients who go to emergency departments due to a DRP, is associated with an increase in the number of repeat visits to the health system
Summary
Over the last 40 years, developed countries have experienced a progressive aging of their population, with an increase in the number of patients with multiple chronic conditions and, the number of patients receiving multiple medications (Colchero et al, 2016; Salive, 2013).It is known that multiple medications are associated with an increase in hospital admissions and visits to emergency departments, as well as an increase in costs for the health system (Burnier, 2017; Gellad et al, 2011; Peterson et al, 2003; Simpson et al, 2006). Several studies have associated a high therapeutic complexity with a lack of adherence to the treatment, as well as an increase in adverse effects (Mansur et al, 2012; Salvi et al, 2017), especially in elderly patients (Onder et al, 2002). 50%, with it being higher in those patients who suffer any adverse event associated with their treatment, as well as in those with more complex treatment regimens (Marcum & Gellad, 2012). Different scales have been validated over the past few years to assess the pharmacotherapeutic complexity in these patients on multiple medications (Paquin et al, 2013), highlighting among them, the scale published by George et al (2004). The information is limited as regards the relationship of these scales with the likelihood of suffering a drug-related
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