Medication regimen complexity and its impact on medication adherence and asthma control among patients with asthma in Ethiopian referral hospitals

IntroductionGood adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension.MethodsAccording to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score.ResultsAmong 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar.ConclusionOur study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.

BackgroundDifferent studies reported that higher diabetes-specific Medication Regimen Complexity Index (MRCI) has a negative impact on glycemic control potentially by decreasing medication adherence. However, information about regimen complexity and its...

Medication regimen complexity and clinical outcomes in older people

Medication non-adherence and regimen complexity are significant barriers to achieving therapeutic goals. This study aimed to determine the impact of medication regimen complexity, and clinical characteristics of patients on medication adherence in internal medicine outpatients. This prospective cross-sectional study was conducted in the internal medicine and geriatric outpatient clinics of a tertiary university hospital. Adherence was assessed with Medication Adherence Report Scale (MARS-5), and regimen complexity was quantified using the Medication Regimen Complexity Index (MRCI) in 150 patients. The mean age of the participants was 57.53±1.26 years. Only 44% of the participants demonstrated perfect adherence to therapy. The MRCI scores of geriatric patients (median: 11 (3-44) vs 19 (5-65)) and those hospitalized within the last six months (median: 12.75 (3-47) vs 20 (6-65.5)) were significantly higher. Complexity scores related to dosing schedule and instructions for use were especially higher in patients with hypertension or diabetes. No statistically significant correlation was found between the total MRCI score and patient-reported adherence scores (P=0.32). However, geriatric patients and recently hospitalized patients were less likely to fully adhere to therapy (χ2 (1, N=150) = 4.71, P=0.030 and 4.23, P=0.040, respectively). Although a direct correlation between total regimen complexity and self-reported adherence was not observed, complexity poses a significant challenge for specific high-risk groups, including geriatric patients and those with recent hospitalizations. These findings may suggest that providing targeted medication counseling and medication regimen review, particularly in the early post-discharge period, might be crucial for optimizing adherence and clinical outcomes.

ABSTRACTBackgroundDosage forms, dosing frequencies and additional instructions contribute to regimen complexity, which in turn is known to influence treatment outcomes.AimTo evaluate the relationship between complexity of medication regimens and adherence in patients at risk of medication misadventure.MethodA modified Morisky scale was administered to inpatients during their hospital stay. Complexity of the medication regimens at the time of hospital discharge was assessed using the Medication Regimen Complexity Index.ResultsThe 310 subjects had a mean age of 72 years and were using a mean of 10.4 prescribed medications. High adherence was self‐reported by 198 (64%) patients. Unintentional nonadherent behaviour was evident in 80 (26%) patients, while 51 (17%) patients admitted making intentional deviations from the recommended treatment. The reliability of the Morisky scale was poor (α = 0.38; 0.26–0.49). Patients who stopped taking their medicine when feeling worse had significantly less complex (p = 0.01) 'additional instructions' (median 4; 1–12) than those who did not stop their medicines (median 6; 0–18). This association was independent of age, gender and other medication regimen features. There were no significant differences between medication regimen features of patients who were forgetful, careful, and who stopped their medications when feeling better and their respective counterparts.ConclusionPatients using medications with less complex additional instructions were more likely to stop taking their medicine when feeling worse. Interventions designed to improve adherence by reducing regimen complexity are unlikely to be effective in all patients, especially in those with intentional nonadherence.

Elderly individuals often experience multiple comorbidities, requiring the use of several pharmacological therapies to improve their quality of life and extend life expectancy. However, medication non-adherence is a common issue in this population, potentially leading to significant clinical complications and increased healthcare costs. This study aims to evaluate medication regimen complexity and adherence among senior citizens in Nepal. Specifically, it explores factors associated with medication complexity and adherence, and examines the relationship between the two variables in the elderly population. A cross-sectional descriptive study was conducted in selected wards of Chandragiri Municipality. Medication regimen complexity was assessed using the validated Medication Regimen Complexity Index (MRCI), while medication adherence was measured using Morisky Green Levine Adherence (MGLA) scale. Descriptive statistics (mean, standard deviation, frequency, and percentage) were used to summarize the data. Pearson's chi-square test and correlation analysis were applied to examine the associations between MRCI levels and medication adherence. Ordinal logistic regression analysis was used to determine the impact of MRCI and other associated variables on adherence. A p-value <0.05 was considered statistically significant, and results were reported using adjusted odds ratios (AOR) with 95% confidence intervals (CI). Out of 422 eligible participants, the majority of participants had a high MRCI score. A statistically significant association was found between MRCI and medication adherence (p < 0.05). Specific comorbidities, including diabetes mellitus, benign prostate hyperplasia (BPH), gastroesophageal reflux disease (GERD), thyroid disorder, chronic obstructive pulmonary disease (COPD), and coronary artery disease was significantly associated with increased MRCI scores. A weak positive correlation was observed between overall MRCI and adherence (r = 0.21), indicating a slight increase in adherence with increasing regimen complexity. Dosing frequency showed a strong correlation with MRCI (r = 0.92, p < 0.01) followed by total medication count, additional directions and dosage forms. In adjusted analysis, participants with higher MRCI level had significantly higher odds of non-adherence (AOR = 2.31, 95% CI: 1.03, 5.15). Additionally, individuals with ≥4 illnesses were more likely to be non-adherent (AOR = 3.82, 95% CI: 1.86-7.83) compared to those with two illnesses. Most participants exhibited high medication regimen complexity, which negatively impacted adherence levels. These findings underscore the importance for healthcare providers to implement strategies aimed at simplifying medication regimens and supporting adherence, particularly among elderly individuals with multimorbidity.

Medication regimen complexity (MRC) is suspected to hinder medication adherence in patients with multiple illnesses. Despite this, the specific impact on Ethiopian patients with multimorbidity is unclear. This study assessed MRC and its impact on medication adherence in patients with multimorbidity. A hospital-based cross-sectional study was conducted on patients with multimorbidity who had been followed at the University of Gondar Comprehensive and Specialized Hospital (UoGCSH), Ethiopia, from May to July 2021. Medication complexity was measured using the validated Medication Regimen Complexity Index (MRCI) tool, and the Adherence in Chronic Diseases Scale (ACDS) was used to measure medication adherence. Pearson's chi-square test was used to examine associations between MRCI levels and medication adherence. Ordinal logistic regression analysis was used to determine the impact of MRC and other associated variables on medication adherence. Statistical significance was determined using the adjusted odds ratio (AOR) at p-value <0.05 and its 95% confidence range. Out of 422 eligible patients, 416 (98.6%) were included in the study. The majority of participants (57.2%) were classified as having a high MRCI score with a mean (±SD) score of 9.7 (±3.4). Nearly half of the patients (49.3%) had low medication adherence. Patients with medium (AOR = 0.43, 95% CI: 0.04, 0.72) and higher (AOR = 0.31, 95% CI: 0.07, 0.79) MRCI levels had lower odds of medication adherence. In addition, monthly income (AOR = 4.59, 95% CI: 2.14, 9.83), follow-up durations (AOR = 2.31, 95% CI: 1.09, 4.86), number of medications (AOR = 0.63, 95% CI: 0.41, 0.97), and Charlson comorbidity index (CCI) (AOR = 0.36, 95% CI: 0.16, 0.83) were significantly associated with medication adherence. Medication regimen complexity in patients with multimorbidity was found to be high and negatively impacted the levels of medication adherence. Healthcare providers and other stakeholders should seek interventions aimed at simplifying drug regimen complexity and improving adherence.

Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD. This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2 ) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Factors associated with the MRCI and MMAS-8 score were determined using either multivariable linear or ordinal logistic regression analysis. In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS-8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS-8. Female sex, comorbidity and use of phosphate binders were associated with more-complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.

Higher BMI is associated with worse asthma control and quality of life but not asthma severity

Purpose This study determined whether discharge medication regimens that patients managed at home following hip or knee total joint arthroplasty differed between men and women. Comparisons were made among overall complexity of the regimen and the separate components contributing to complexity: number of medications, dosage forms, dosing frequencies, and additional administration directions. Methods Patient demographics and discharge medication regimens for serially discharged patients were retrospectively collected for a 3-month period from medical records at a large urban acute care hospital. Complexity of discharge medication regimens was quantified with the Medication Regimen Complexity Index (MRCI), which accounts for each separate component of complexity. Results The serial sample comprised 105 men and 93 women discharged to home following total joint arthroplasty. Men and women did not differ by hospital length of stay or by proportions with the most common secondary diagnoses (hypertension, hyperlipidemia, diabetes). Women were discharged with significantly more complex medication regimens to manage at home than men ( P = .047). Among the individual components contributing to complexity, women were discharged with significantly more medications on their lists than men ( P = .006) and had significantly larger dosing frequency scores than men ( P = .01). Conclusions Women discharged to home following lower extremity total joint arthroplasty may be at greater risk for an adverse drug event than men due to increased medication regimen complexity. These findings suggest that attempts should be made to mitigate this risk through reduced regimen complexity, specifically targeting dosing frequency, increased education for patients with complex regimens, or increased monitoring.

Although the use of highly active antiretroviral therapy in the treatment of HIV infection has led to considerable improvement in morbidity and mortality, unless patients are adherent to their drug regimen (i.e., at least 90 to 95% of doses taken), viral replication may ensue and drug-resistant strains of the virus may emerge. The authors studied the extent to which neuropsychological compromise and medication regimen complexity are predictive of poor adherence in a convenience sample of 137 HIV-infected adults. Medication adherence was tracked through the use of electronic monitoring technology (MEMS caps). Two-way analysis of variance revealed that neurocognitive compromise as well as complex medication regimens were associated with significantly lower adherence rates. Cognitively compromised participants on more complex regimens had the greatest difficulty with adherence. Deficits in executive function, memory, and attention were associated with poor adherence. Logistic regression analysis demonstrated that neuropsychological compromise was associated with a 2.3 times greater risk of adherence failure. Older age (>50 years) was also found to be associated with significantly better adherence. HIV-infected adults with significant neurocognitive compromise are at risk for poor medication adherence, particularly if they have been prescribed a complex dosing regimen. As such, simpler dosing schedules for more cognitively impaired patients might improve adherence.

Introduction: Medication adherence is essential for treatment and recovery following hematopoietic stem cell transplantation (HSCT). However, limited data exist on the most effective methods to measure adherence and the factors influencing it in HSCT patients. Materials and Methods: A prospective longitudinal study assessed immunosuppressant medication adherence in 150 patients with hematologic malignancies undergoing allogeneic HSCT. Adherence was assessed using pill counts, immunosuppressant medication levels, patient-reported medication logs, and the Medication Adherence Response Scale-5 (MARS-5) at 30, 100, and 180 days post-HSCT. We evaluated adherence rates, agreement between methods, and sociodemographic and clinical predictors. From patient-reported logs, we calculated dose adherence (comparing reported doses to expected doses) and timing adherence (comparing medication intake within ±3 h of the prescribed time). Kappa analysis assessed agreement among methods. Results: Of 190 eligible patients, 150 (78.9%) enrolled. The mean age was 57.5 years (SD = 13.5); 41.3% (n = 62) were female, 85.3% (n = 128) were non-Hispanic White, and 73.3% (n = 110) were married or living with a partner. Medication adherence varied across the three timepoints and by measurement type: 52-64% (pill counts), 18-24% (medication levels), 96-98% (medication log dose adherence), 83-84% (medication log timing adherence), and 97-98% (MARS-5). There was minimal agreement between measures (Kappa range: 0.008-0.12). Conclusions: Despite the feasibility of leveraging objective and patient-reported measures to assess medication adherence in HSCT patients, there was little agreement between these measures. Patient-reported measures showed high adherence, while objective measures like pill counts and medication levels revealed more modest adherence. The complexity of medication regimens likely contributes to this discrepancy. A rigorous approach to understanding medication adherence in the HSCT population may entail both objective and subjective measures of medication adherence.

Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p<.05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.

Review question/objective The objective of this systematic review is to identify the best available research evidence related to the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in people with chronic respiratory diseases, focusing on measures of adherence and health outcomes. The specific review questions to be addressed are: 1. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy in terms of inhalation regimens and inhalation techniques in people with chronic respiratory diseases? 2. What is the effectiveness of educational and supportive interventions for improving adherence to inhalation therapy on health service utilization and patient outcomes including symptoms, pulmonary function, and quality of life? 3. What is the effectiveness of various designs, in terms of components, modes and intensities, of educational and supportive interventions for improving adherence to inhalation therapy? Inclusion criteria Types of participants This review will consider studies that include adults aged 18 or above, with a clinical diagnosis of chronic respiratory disease and prescribed self-administered inhalation therapy as a long term regular treatment, irrespective of the type of inhaler used. For the purposes of this review, "chronic respiratory diseases" is defined by WHO in 2007 as "the chronic diseases of the airways and other structures of the lung" (p.5). 1 Inhalation therapy is defined as "a treatment in which a substance is administered to the respiratory tract with inspired air". 6 This review will focus on inhalation of drugs. Those studies with prescribed administration of oxygen and water will be excluded. There is no universal standard for how long a treatment is undertaken to be defined as a "long term treatment". Acute episodic drug treatments, such as a course of antibiotics, will be excluded. Types of interventions of interest All educational interventions, with or without supportive programs, designed to improve the chronic respiratory disease sufferers inhalation technique and adherence to their prescribed inhalation therapy will be considered. Those studies that involve comparison of different types of inhalation medications, inhaler devices or inhalation methods to improve the adherence to inhalation therapy will be excluded. For the TRUNCATED AT 350 WORDS

Objective To identify the risk factors that influence patient adherence with the prescribed medication and their association with asthma control. Methodology Total 310 children with persistent asthma from inpatient and outpatient department of children hospital were included in this study. The medication adherence was assessed by using Morisky medication adherence assessment questionnaire (MMAS).Children were classified as having well controlled, partially controlled or uncontrolled asthma based on Gina guidelines. Data was analysed using SPSS version 20. Results Out of 310 children 202 (65%) were male and 108 (34.83%) were female. Mean age was 8.9±3.5 years. Total 231 (74.5%) belong to poor socioeconomic status, 71 (22.9%) to middle class and 8 (2.6%) to upper class. Regarding the asthma control 66 (21.3%) were having well controlled asthma, 71 (22.9%) partially controlled and 173 (55.8%) uncontrolled asthma. Low adherence i.e (MMAS score Conclusion Adherence with medication regimen is essential for attaining maximal therapeutic benefits. Poor socioeconomic status, poor understanding of treatment regimen, high cost of medication and alternative medication use are important risk factors for poor adherence to medication leading to uncontrolled asthma. It is important to incorporate strategies in asthma treatment plan to improve patient adherence.