Complex Medication Regimens Research Articles

FACTORS ASSOCIATED WITH OLDER ADULTS’ READINESS FOR DISCHARGE FROM POST ACUTE CARE TO HOME

Abstract Following acute hospitalization, older adults are often transferred to post-acute care (PAC) for rehabilitation and nursing care. Most PAC admissions are comprised of adults with multimorbidity (>2 chronic diseases). After PAC discharge many patients are rehospitalized within 30 days. The goal of this study was to evaluate factors associated with older adult’s readiness for PAC discharge to home. A prospective one-arm descriptive correlation study was conducted. Older adults (N=19) discharged from PAC to home participated. Subjects were recruited over a 3-month period from a large midwestern facility. Participants completed the Patient Readiness for Hospital Discharge -Short Form (PR RHDS-SF) and Patient Activation Measure (PAM). Medication burden, measured by the medication regimen complexity index (MRCI) calculated from discharge medication record. Participants included 12 females and 5 males, mean age of 73 (SD 8.2)) years. The PT RHDS -SF mean score was 49.3 (SD 16.8). The PAM mean score was 54.7 (SD 7.4). Medication burden was high, mean MRCI was 31.5 (SD 11.6). There was a significant correlation [r (17) .48, p=.04] between total PT RHDS-SF score and patient activation levels. Preparing PAC patients to self-manage their multimorbid conditions may enhance their self-confidence with transition from PAC to home. Evaluating self-management preparedness of older adults prior to PAC discharge is vastly understood. Research is needed to prepare multimorbid older adult patients transitioning from PAC to home focused on perceived readiness and self-management confidence.

Key Features of Smart Medication Adherence Products: Updated Scoping Review.

Older adults often face challenges in self-managing their medication owing to physical and cognitive limitations, complex medication regimens, and packaging of medications. Emerging smart medication dispensing and adherence products (SMAPs) offer the options of automated dispensing, tracking medication intake in real time, and reminders and notifications. A 2021 review identified 51 SMAPs owing to the rapid influx of digital technology; an update to this review is required. This review aims to identify new products and summarize and compare the key features of SMAPs. Gray and published literature and videos were searched using Google, YouTube, PubMed, Embase, and Scopus. The first 10 pages of Google and the first 100 results of YouTube were screened using 4 and 5 keyword searches, respectively. SMAPs were included if they were able to store and allowed for the dispensation of medications, tracked real-time medication intake data, and could automatically analyze data. Products were excluded if they were stand-alone software applications, not marketed in English, not for in-home use, or only used in clinical trials. In total, 5 researchers independently screened and extracted the data. This review identified 114 SMAPs, including 80 (70.2%) marketed and 34 (29.8%) prototypes, grouped into 15 types. Among the marketed products, 68% (54/80) were available for consumer purchase. Of these products, 26% (14/54) were available worldwide and 78% (42/54) were available in North America. There was variability in the hardware, software, data collection and management features, and cost of the products. Examples of hardware features include battery life, medication storage capacity, availability of types and number of alarms, locking features, and additional technology required for use of the product, whereas software features included reminder and notification capabilities and availability of manufacturer support. Data capture methods included the availability of sensors to record the use of the product and data-syncing capabilities with cloud storage with short-range communications. Data were accessible to users via mobile apps or web-based portals. Some SMAPs provided data security assurance with secure log-ins (use of personal identification numbers or facial recognition), whereas other SMAPs provided data through registered email addresses. Although some SMAPs were available at set prices or free of cost to end users, the cost of other products varied based on availability, shipping fees, and subscription fees. An expanding market for SMAPs with features specific to at-home patient use is emerging. Health care professionals can use these features to select and suggest products that meet their patients' unique requirements.

Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review.

Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD. To characterize peer reviewed literature on the role of pharmacists in supporting medication adherence of patients with chronic kidney disease and highlight the impact they might have in the health outcomes for patients. This review was performed in accordance with the Scoping Review Framework outlined in the Joanna Briggs Institute Reviewer's Guide. Four electronic databases were searched (Medline (Ovid), Emcare, Scopus and Web of Science) for all relevant literature published up until November 2022. A total of 32 studies were reviewed against an exclusion and inclusion criteria, with findings from each study categorized into barriers, interventions, perceptions, financial implications and outcomes. Eight eligible studies were identified, where pharmacists' interventions including medication reconciliation, medicine reviews, patient counselling and disease state and medication education, were all reported to have a positive effect on medication adherence. Although pharmacy services in chronic kidney disease were acceptable to patients and pharmacists, these services were under-utilized and limited by logistical constraints, including staffing shortages and time limitations. Patient education supplemented with education tools describing disease states and medications was reported to increase patient adherence to medication regimes. Pharmacist-led interventions play an integral role in improving medication adherence in patients with chronic kidney disease, with their inclusion in renal care settings having the potential to improve outcomes for patients.

Medication adherence in pediatric kidney transplantation: Howto build a bridge over troubled water.

Adhering to the immunosuppressive regimen remains one of the biggest challenges for children and adolescents after kidney transplantation. The first paper on nonadherence, co-authored by Dr. Fine, appeared in Pubmed over 45 years ago. Since then, many clinicians and researchers tried to better understand nonadherence and are looking for effective ways to support young people in implementing the complex medication regimen in their daily lives. As a tribute to Dr. Fine, we conducted a comprehensive review providing an overview of adherence-enhancing interventions in the field of pediatric kidney transplantation, thereby focusing on strategies that not only are effective but can also be embedded in daily clinical practice successfully and sustainably. This overview is preceded by a discussion about how to find out who is in need of supportive interventions. We will also argue that interventions should already start before pediatric kidney transplantation and discuss how to decide whether or not a young patient with nonadherence-induced graft loss should undergo retransplantation. We hope this comprehensive overview will rekindle the hope that we can finally turn the tide and beat one of pediatric kidney transplantation's main enemies.

Machine learning vs. traditional regression analysis for fluid overload prediction in the ICU

Fluid overload, while common in the ICU and associated with serious sequelae, is hard to predict and may be influenced by ICU medication use. Machine learning (ML) approaches may offer advantages over traditional regression techniques to predict it. We compared the ability of traditional regression techniques and different ML-based modeling approaches to identify clinically meaningful fluid overload predictors. This was a retrospective, observational cohort study of adult patients admitted to an ICU ≥ 72 h between 10/1/2015 and 10/31/2020 with available fluid balance data. Models to predict fluid overload (a positive fluid balance ≥ 10% of the admission body weight) in the 48–72 h after ICU admission were created. Potential patient and medication fluid overload predictor variables (n = 28) were collected at either baseline or 24 h after ICU admission. The optimal traditional logistic regression model was created using backward selection. Supervised, classification-based ML models were trained and optimized, including a meta-modeling approach. Area under the receiver operating characteristic (AUROC), positive predictive value (PPV), and negative predictive value (NPV) were compared between the traditional and ML fluid prediction models. A total of 49 of the 391 (12.5%) patients developed fluid overload. Among the ML models, the XGBoost model had the highest performance (AUROC 0.78, PPV 0.27, NPV 0.94) for fluid overload prediction. The XGBoost model performed similarly to the final traditional logistic regression model (AUROC 0.70; PPV 0.20, NPV 0.94). Feature importance analysis revealed severity of illness scores and medication-related data were the most important predictors of fluid overload. In the context of our study, ML and traditional models appear to perform similarly to predict fluid overload in the ICU. Baseline severity of illness and ICU medication regimen complexity are important predictors of fluid overload.

The Impact of Resilience and Perceived Autonomy Support on Medication Adherence Among Rural Older Adults With Hypertension.

Adherence to antihypertension medications has been explored in previous studies; however, these studies generally focus on individuals who reside in urban areas. Improved understanding is needed regarding rural older adults who are self-managing medications for hypertension and the motivational factors that may influence adherence. The purpose of this study was to examine medication adherence among rural older adults with hypertension and the association with motivational factors as defined in self-determination theory, including quality of motivation (autonomous vs controlled), perceived competence, perceived autonomy support, and basic psychological needs satisfaction. Rural nursing theory was also used to explore the concept of resilience. This cross-sectional study involved 80 older adults (≥65 years old) self-managing at least 1 prescribed medication for managing their hypertension. Participants ranged in age from 65 to 89 (mean [SD], 74.04 [6.18]) years from rural areas in the northwest. Participants completed a demographic questionnaire, a measure of medication adherence, and questionnaires to assess perceived autonomy support, basic needs satisfaction, autonomous and controlled motivation, perceived competence, and resilience. Correlational analysis and multiple regression were used to examine associations and predict adherence. Perceived autonomy support, resilience, cost of medication, and medication regimen complexity were the only variables significantly associated with medication adherence and predicted adherence. Resilience mediated the relationship between perceived autonomy support and medication adherence. Overall, findings indicate high levels of adherence. Interventions that enhance perceptions of autonomy support and resilience may be useful in managing hypertension.

Patient (pt) Experiences of Receiving Idecabtagene Vicleucel (Ide-Cel, bb2121) Versus Standard (Std) Regimens for the Treatment (Tx) of Relapsed/Refractory Multiple Myeloma (RRMM) in the Randomized, Controlled KarMMa-3 Clinical Trial: Analysis of Longitudinal Qualitative Interviews

Introduction: Ide-cel is a first-in-class B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T cell therapy approved by the United States (US) Food and Drug Administration; the European Medicines Agency; and Japan's Ministry of Health, Labour, and Welfare for treating adult pts with RRMM who were triple-class exposed (TCE) to an immunomodulatory (IMiD) agent, proteasome inhibitor (PI), and anti-CD38 monoclonal antibody and who experienced disease progression/relapse after last therapy. The phase 3 multicenter, open-label, randomized controlled KarMMa-3 trial (NCT03651128) enrolled pts with RRMM who were TCE (including an IMiD agent, PI, and daratumumab [DARA]) after 2-4 prior lines of therapy. Pts were randomized 2:1 to receive either ide-cel or 1 of 5 std regimens (DARA, pomalidomide [POM], dexamethasone [DEX]; DARA, bortezomib, DEX; ixazomib, lenalidomide, DEX; carfilzomib and DEX; elotuzumab, POM, DEX). At median follow-up (18.6 mo), median progression-free survival (13.3 vs 4.4 mo) and response rate (71% vs 42%) were significantly higher in the ide-cel versus std regimen arm (Rodriguez-Otero P, et al. N Engl J Med 2023;388:1002-1014). In addition to the standard pt-reported outcomes instruments, trial-embedded interviews provide further insights into the patient Tx experience (Delforge M, et al. J Clin Oncol 2023;41[suppl 16]. Abstract 8032). This study assessed Tx experience, changes in health-related quality of life, and advantages and disadvantages of assigned Tx for pts enrolled in the KarMMa-3 trial. Methods: To obtain pts' experiences and perspectives in their own words while on the assigned Tx arms during the study, qualitative interviews were embedded into the KarMMa-3 trial. Pts were randomized (1:4) to participate in a series of optional qualitative interviews conducted at baseline (BL), and 3 and 6 mo post Tx. Interviews were audio-recorded and transcribed. Non-English interviews were transcribed directly into English. Transcripts were analyzed in MAXQDA qualitative analysis software; inter-coder agreement exercises were completed to ensure reliability. Analytic approaches included thematic analysis and longitudinal analysis across aspects of health and well-being. Results: In total, 64 pts (n = 43 ide-cel, n = 21 std regimen) across 9 countries in Europe and in the USA participated in ≥ 1 interview. Across both arms, 60, 48, and 38 pts completed interviews at BL, and 3 and 6 mo post Tx, respectively. The mean (median) age of interviewed pts at time of consent in the trial was 60.5 (60) years, and 33% were female. When describing their overall well-being during the previous 4 weeks at 3 mo, 53% of ide-cel pts described their well-being as mostly improved versus 19% in the std regimen arm. In the ide-cel arm, 59% and 56% of pts reported improvements in physical health versus 19% and 10% of pts in the std arm at 3 and 6 mo from BL, respectively; 25% and 28% of pts in the ide-cel arm reported worsening physical health at 3 and 6 mo from BL versus 63% and 80% of pts in the std arm (Table 1). In the ide-cel arm, 47% and 48% of ide-cel pts described improvements in physical functioning at 3 and 6 mo from BL versus 19% and 20% of std regimen pts, respectively; 22% and 16% of pts in the ide-cel arm versus 50% and 60% of pts in the std arm reported worse physical functioning at 3 and 6 mo from BL. Regarding Tx advantages, ide-cel pts reported efficacy (n = 25, 58%), minimal side effects (n = 21, 49%), avoidance of other therapies (n= 16, 37%), and having a 1-time Tx (n = 12, 28%). Std regimen pts also described efficacy (n = 10, 48%) and minimal side effects (n = 8, 38%) as Tx advantages. Disadvantages discussed by pts treated with ide-cel included lack of efficacy (n = 10, 23%), side effects after infusion (n = 9, 21%), or none (n = 9, 21%). Greater proportions of std regimen pts described side effects (n = 9, 43%) and lack of efficacy (n = 7, 33%). Additional well-being results for both arms are presented in Table 1. Conclusions: This study provides unique insight into key pt perceptions of ide-cel Tx compared to std regimens. Overall, pts receiving ide-cel reported more positive changes 6 mo post Tx than pts receiving std regimens, specifically in physical health and functioning. Fewer pts treated with ide-cel described side effects than pts receiving std regimens. These data show that ide-cel as a 1-time infusion can alleviate the burden of managing complex medication regimens in TCE early-line relapse pts.

Prevalence of polypharmacy and pharmacotherapy complexity in elderly people living with HIV in Spain. POINT study

ObjectiveTo determine the prevalence of polypharmacy in persons living with HIV of at least 65 years of age receiving antiretroviral treatment. A characterization of antiretroviral treatment, as well as a determination of the prevalence of comorbidities; of the most common types of concomitant medication; of adherence rates; of the pharmacotherapeutic complexity; and of drug-drug interactions were also among the goals of the study. MethodTh is was a multi-center, cross-sectional observational study that included persons living with HIV aged 65 years or more who were on active antiretroviral treatment. Demographic, clinical (viral load, CD4 count and comorbidities) and pharmacotherapeutic (type of antiretroviral treatment: single tablet regimen, polypharmacy [six active ingredients or more] and major polypharmacy [11 active ingredients or more] variables were considered). Adherence to antiretroviral treatment was measured by dispensation records and the Simplified Medication Adherence Questionnaire, while adherence to concomitant medication was measured using dispensation records and the Morisky-Green questionnaire. The Medication Regimen Complexity Index was calculated. Drug-drug interactions were analyzed using the Liverpool and Lexicomp databases. ResultsSeventy-four patients (86.5% male) were included, with a median age of 69 years (66.7-72.0). The sexual route was the most common route of transmission of the disease (67.6%). The virus was undetectable in 89.2% of patients; the CD4 count was over 200/mL in 94.6% of the sample. The median number of comorbidities was 3.5 (2.0-5.0), 52.7% of them being cardiovascular; 50.0% related to the central nervous system; 176% hepatic; and 8.1% consisting in chronic pulmonary disease. A total of 81.1% of patients received triple therapy and 48.6% single tablet regimen. The median number of concomitant drugs administered was 5.0 (2.0-70), polypharmacy was observed in 71.6% of cases and major polypharmacy in 25.7%. Antihypertensive and cardiovascular drugs were prescribed to 56.8% of patients, lipid-lowering drugs to 50.0%, antiulcer agents to 33.8% and psychoactive drugs to 32.4%. According to dispensation records, adherence to antiretroviral treatment was 85.1% and to concomitant medication 62.8%. The median Medication Regimen Complexity Index for the whole treatment was 13.0 (8.0-176). Potential drug-drug interactions were observed in 55.4% of patients and contraindicated interactions in 12.2%. ConclusionsElderly persons living with HIV exhibit a high prevalence of polypharmacy, pharmacotherapeutic complexity, poor adherence and drug-drug interactions. For that reason, pharmacotherapeutic optimization must be a priority in these patients.

Concordance between pharmacotherapeutic complexity calculated and perceived by HIV+ patients with antiretroviral treatment

ObjectiveTo determine the difference between the pharmacotherapeutic complexity index by Medication Regimen Complexity Index and it's perceived by patients through a visual analogue scale in patients HIV+ with antiretroviral treatment. MethodProspective, observational study of patients HIV+ > 18 years of age with stable antiretroviral treatment in the last three months, followed up by external consultations of pharmaceutical care between October’17 and February’18. The main variable of the study was the concordance between the median of the score obtained in the pharmacotherapeutic complexity perceived by the patients using the visual analog scale whose range of values oscillates between 0–10, categorized in low complexity (0–1) and high complexity (2–10), and the median of the score obtained for the theoretical pharmacotherapeutic complexity using the Medication Regimen Complexity Index tool whose ranges of values oscillate between 1 and infinity, categorized in low complexity (0–11) and high complexity > 11. The overall complexity was calculated: antiretroviral treatment and concomitant treatment. Results: We included 236 patients in the study. There was a discrete concordance between the pharmacotherapeutic complexity perceived by the patients and that calculated according to the Medication Regimen Complexity Index tool (Cohen's Kappa index 0.203). The median of the Medication Regimen Complexity Index of the total medication was 6 (interquartile range: 4–10) versus the median of the Complexity Index measured by visual analog scale of 2 (interquartile range: 0–4). ConclusionsPatients perceive a pharmacotherapeutic complexity lower than that calculated. Therefore, we must include the two scales in pharmaceutical care for a better understanding of the patient's perception.

Prevalence, associated factors and clinical implications of medication literacy linked to frailty in hemodialysis patients in China: a cross-sectional study

BackgroundMaintenance hemodialysis (MHD) patients have complex medication regimens that require a high level of skill to interpret medication information. However, there is currently a lack of research evaluating the ability to read and understand medication labels in Chinese MHD patients. In addition, the relationship between frailty and medication literacy among MHD patients remains unclear. Therefore, this study aims to assess the potential factors affecting medication literacy in MHD patients and to explore the relationship between frailty and medication literacy.MethodsThis cross-sectional study was conducted using convenience sampling in West China Hospital of Sichuan University, China. Using a general questionnaire, we collected demographic, clinical and laboratory data. Medication literacy was assessed by the Chinese Medication Literacy Scale, and frailty was assessed by the FRAIL Scale. Univariate analyses examined potential factors associated with medication literacy. An ordered logistic regression was used to analyze the relationships between medication literacy and these factors. Spearman’s correlation was used to assess the association between medication literacy and frailty.ResultsA total of 290 MHD patients were included in the analysis. Inadequate, marginal, and adequate medication literacy was found in 56 (19.3%), 153 (52.8%), and 81 (27.9%) patients, respectively. Ordered logistic regression revealed factors associated with inadequate medication literacy: age (OR = 0.281, 95% CI = 0.139–0.565, p < 0.001 for < 65 years); education (OR = 8.612, 95% CI = 3.524–21.046, p < 0.001 for ≤ primary school education; OR = 3.405, 95% CI = 1.683–6.887, p = 0.001 for junior high school education); presence of caregiver medication assistance (OR = 2.302, 95% CI = 1.173–4.516, p = 0.015); frailty (OR = 0.440, 95% CI = 0.216–0.893, p = 0.023 for frail patients); and high β2-microglobulin (β2-MG) (OR = 1.010, 95% CI = 1.002–1.019, p = 0.012). Spearman’s analysis showed that medication literacy was negatively correlated with frailty in MHD patients (R=-0.189, p = 0.001).ConclusionsMedication literacy levels in MHD patients needed improvement and were associated with certain patient characteristics, including age, education level, presence of caregiver support, β2-microglobulin levels, and risk of frailty. This study identified subgroups of MHD patients, such as those who were older, had lower education, had caregiver assistance, had high β2-microglobulin levels, or were frail, to have inadequate medication literacy. These findings underscore the need for routine screening and targeted interventions to improve medication literacy in this population.

Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey

BackgroundOlder adults often use multiple medicines to manage comorbidities well or to prevent associated complications. This study aims to determine polypharmacy, the use of potentially inappropriate medications (PIMs) using the 2019 Beers Criteria and to determine the Medication Regimen Complexity Index (MRCI) score. It also aims to identify factors associated with the presence of PIMs and the MRCI score.MethodsThis cross-sectional study was carried out between 6 and 2023 and 5 May 2023 in a community pharmacy in Turkey. Elderly patients over 65 years of age, who used at least one drug, and who came to the pharmacy for any reason were included in the study. PIMs were determined according to the 2019 Beers Criteria. The Turkish validated version of the MRCI was used to determine the medication complexity score.Results200 patients were included in this study. 59.5% of the patients were female and the median age was 70 (IQR, 66-74.75). Polypharmacy was detected in 33% of patients. The use of PIMs was determined in 63.5% of the patients. The median of the MRCI score was 11 (IQR, 7–15). The number of chronic diseases and drugs, presence of polypharmacy, MRCI score and mental disorders were found to be significantly higher in those with PIMs than in those without (p < 0.05). Having less than eight years of education, presence of polypharmacy, the presence of comorbidity (diabetes mellitus, cardiovascular disease, thyroid, chronic obstructive pulmonary disease (COPD), asthma and mental disorders) were associated with significantly higher MRCI scores (p < 0.05).ConclusionsAccording to the results of our study, it was found that the elderly patients who came to the pharmacy had low MRCI scores, but had high PIMs use. Community pharmacists have an important role in identifying inappropriate drug use, so they should be trained to develop skills in identifying and reducing PIMs in older patients.

Polypharmacy as the risk factor of potentially inappropriate medication and medication regimen complexity index in hospitalised elderly patients

Background: The majority of elderly patients often receive complex therapy or polypharmacy due to physiological changes, which can develop into an adverse drug event. Objective: To analyse the risk factors of potentially Inappropriate Medications (PIMs) and medication regimen complexity in elderly patients. Method: This is an observational study with cohort retrospective methods, carried out at the In-patient Unit of Airlangga University Hospital, Surabaya. The inclusion criteria were patients aged ≥ 60 years old who were admitted between January to December 2019 for at least three days and received at least one drug. PIMs were monitored with Beers Criteria 2019 and therapy complexity was measured with Medication Regimen Complexity Index (MRCI) during admission, hospitalisation, and discharge. Result: Among 357 patients, 60.8% received at least one PIM on admission. Furthermore, the MRCI score decreased from 22.7 at the time of admission to 11.5 on discharge. Patients who received polypharmacy were two to three times more at risk of having PIMs (p &lt; 0.001). The number of medications correlated with the MRCI scores (Correlation Coefficient= 0.815–0.877, p &lt; 0.001). Conclusion: Polypharmacy is one of the risk factors of PIMs and medication regimen complexity, elderly patients who receive polypharmacy must be closely monitored to prevent adverse drug reactions.

Medication complexity and COVID-19 pandemic impact on the cost burden in non-COVID elderly patients at the emergency department

Background: The global increase in the elderly population and the incidence of emergency conditions due to physiological changes pose cost challenges for emergency services. COVID-19 potentially affects the financial burden of medication in elderly patients. Objective: To analyse the impact of medication complexity on the cost burden in elderly patients admitted to the Emergency Department (ED) before and during the COVID-19 pandemic. Method: A retrospective observational study was conducted among elderly patients (aged &gt; 60 years) who visited ED but were not hospitalised between January to April 2020. The medication complexity was measured using the Medication Regimen Complexity Index (MRCI) while the cost was collected from the hospital information system. Result: A total of 321 ED visits were included in this study. The results showed that the mean of the total medication was 3.89 ± 1.70, while the mean score of the MRCI was 15.20 ± 6.54. The mean medication cost required was IDR 56,342 for each ED visit. Conclusion: This study provided an overview and input to control medication costs for elderly patients in the emergency setting. Interested parties can design policies that are beneficial in economics and therapeutic outcomes.

Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients Validation of the “MRCI-Arabic”

The medication regimen complexity index is widely used in clinical practice and many studies, to assess the complexity of medication regimens. The goal of this study is to validate the medication regimen complexity index-Arabic (MRCI-Arabic) version among older patients. Methods: This methodologic study was conducted in older patients (≥ 65 years old) who were native Arabic speakers at a community pharmacy located in Istanbul, Turkey. After the translation and cultural adaptation process finished, medication regimens of 30 patients were evaluated for test-retest reliability three weeks apart by the rater who was a native Arabic speaker. The inter-rater correlation was calculated in study population (n =100). The link between the number of medications and the score of medication regimen complexity was used to assess convergent validity. The difference in the score of pharmaceutical regimen complexity in stratified age groups was used to examine discriminant validity. Results: The inter-rater and test-retest reliability of the MRCI-Arabic total scale and its subsection were extremely high (Spearman’s rho ranged from 0.996 to 1; p &lt;0.001). There was a strong and positive correlation between the total MRCI-Arabic score and the number of medications (r = 0.830; p &lt; 0.001), the number of chronic diseases (r = 0.641; p &lt; 0.001). Conclusion: The Arabic validation of the MRCI is a validated tool that can be used by native Arabic-speaking healthcare professionals to determine the complexity of their patients’ medication regimens.

Factors Affecting Glaucoma Medication Adherence and Interventions to Improve Adherence: A Narrative Review.

Glaucoma is a leading cause of vision loss. First line therapy for primary open angle glaucoma (POAG) are topical ocular hypotensive drops. Patient adherence with topical therapy for glaucoma is a significant challenge with a reported adherence of 60%. The purpose of this review is to discuss factors associated with glaucoma adherence (including demographic factors, cost, patient education, health beliefs, treatment burden and regimen, and physical limitations) and to explore potential interventions to improve medication adherence. Articles included in this review were found by searching PubMed and Google Scholar using the key words "Glaucoma Treatment Adherence" and "Glaucoma Treatment Compliance." Data from this review demonstrates that higher medication cost, lower patient education/literacy levels, and being of African and Hispanic descent are associated with lower medication adherence rates. The data is inconclusive on whether medication regimen complexity lowers patient medication adherence rates. Interventions that have successfully improved medication adherence rates for minority patients have focused on building trust and addressing fears and false beliefs. For cost, explicit physician communication to patients regarding medication cost is important and can help the physician determine any patient concerns about cost. Outside the USA, adherence has been improved through adherence-contingent rebate systems and government subsidies. Most interventions that aim to increase adherence target patient education and literacy with the following interventions demonstrating efficacy: written instructions targeting glaucoma-specific health literacy, literacy level appropriate glaucoma education videos, and interactive and personalized educational programs. More clinic infrastructure and programs that utilize patient reminder tools and patient educators could help physicians and patients in support of these personalized action plans.

Smart Pill Box with Voice Announcement and Wrist Band Accessory

A project has been developed to address the challenges faced by individuals in managing complex medication regimens independently. The solution incorporates various components, including the NodeMCU ESP32 Wroom, RTC module, GSM module, Smart Pill Box dispenser, and a wristband. The NodeMCU ESP32 Wroom module enables seamless communication and synchronization between the Smart Pill Box Dispenser and the wristband accessory. By leveraging its Wi-Fi capabilities, the NodeMCU ESP32 Wroom ensures that the dispenser and wristband stay connected, facilitating real-time notifications related to medication schedules and reminders. To ensure accurate timekeeping and synchronization, an RTC (Real-Time Clock) module is integrated into the system. The GSM module is utilized for the SMS alert functionality of the system. In the event that a patient neglects to take their medication, the GSM module sends an alert message to a designated person, notifying them of the situation. A wristband accessory is a piece of equipment that the patient wears constantly. It includes LCD display, MAX30102 sensor, body temperature sensor, and vibrator, among other things. The MAX30102 sensor measures the patient's heart rate, SpO2, and temperature, while the temperature sensor measures the patient's body temperature. These values are all shown on an LCD screen. By leveraging IoT technology, the solution enhances medication adherence, improves safety, and reduces the need for constant medical supervision, thereby promoting the well-being and independence of the users.

The Stiff Joint: Comparative Evaluation of Monotherapy and Combination Therapy With Urate Lowering Agents in Managing Acute Gout.

Gout, an extremely painful form of arthritis, is triggered by the innate immune system's response to the accumulation of monosodium urate crystals in specific joints and surrounding tissues. This condition is characterized by recurring episodes of excruciating arthritis flares, interspersed with periods of disease quiescence. Over time, gout can result in disability, tophi formation, and severe pain. The treatment of gout is centered around two main objectives: alleviating inflammation and pain during acute gout attacksand long-term management to reduce serum urate levels and mitigate the risk of future attacks. Addressing inflammation and pain during acute attacks is often complicated by various factors, including underlying health conditions commonly associated with gout, such as hypertension, chronic kidney disease, cardiovascular disease, and diabetes mellitus. Moreover, gout patients are frequently older and have multiple coexisting health issues, necessitating complex medication regimens. Given the rising prevalence of gout and its associated comorbidities, there's a growing demand for improved treatment options. While existing treatments effectively manage gout in some patients, a significant portion, particularly those with comorbidities, face contraindications to these treatments and require alternative approaches. Innovative medications are required to enhance gout treatment, especially for individuals with concurrent health conditions. These considerations underscore the importance of reviewing both monotherapy and combination therapy approaches for acute gout treatment.

Translating digital healthcare to enhance clinical management: a protocol for an observational study using a digital health technology system to monitor medication adherence and its effect on mobility in people with Parkinson’s

IntroductionIn people with Parkinson’s (PwP) impaired mobility is associated with an increased falls risk. To improve mobility, dopaminergic medication is typically prescribed, but complex medication regimens result in suboptimal adherence....

Optimizing Pharmacist Team-Integration for ICU Patient Management: Rationale, Study Design, and Methods for a Multicentered Exploration of Pharmacist-to-Patient Ratio.

The workload of healthcare professionals including physicians and nurses in the ICU has an established relationship to patient outcomes, including mortality, length of stay, and other quality indicators; however, the relationship of critical care pharmacist workload to outcomes has not been rigorously evaluated and determined. The objective of our study is to characterize the relationship of critical care pharmacist workload in the ICU as it relates to patient-centered outcomes of critically ill patients. Optimizing Pharmacist Team-Integration for ICU patient Management is a multicenter, observational cohort study with a target enrollment of 20,000 critically ill patients. Participating critical care pharmacists will enroll patients managed in the ICU. Data collection will consist of two observational phases: prospective and retrospective. During the prospective phase, critical care pharmacists will record daily workload data (e.g., census, number of rounding teams). During the retrospective phase, patient demographics, severity of illness, medication regimen complexity, and outcomes will be recorded. The primary outcome is mortality. Multiple methods will be used to explore the primary outcome including multilevel multiple logistic regression with stepwise variable selection to exclude nonsignificant covariates from the final model, supervised and unsupervised machine learning techniques, and Bayesian analysis. Our protocol describes the processes and methods for an observational study in the ICU. This study seeks to determine the relationship between pharmacist workload, as measured by pharmacist-to-patient ratio and the pharmacist clinical burden index, and patient-centered outcomes, including mortality and length of stay.

Medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in a rural area

Background &amp; Aim: Older adults with chronic diseases are usually required to manage multiple medications and complex medication regimens. Medication adherence is crucial in older adults which is increasingly being recognized due to its potential to impact healthcare utilization and treatment efficacy. The current study aimed to assess medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in rural areas. ‎&#x0D; Methods &amp; Materials: A cross-sectional study design was used to achieve the study aim. The study sample was composed of 310 older patients from a rural area in Sharkia Governorate, Egypt. Medication adherence was assessed by the Arabic version of the General Medication Adherence Scale. Association between medication adherence and older patients' characteristics was identified through the Chi-square test, Pearson's correlation coefficient, and Logistic regression.&#x0D; Results: Among 310 older patients, 84.8% of them were non-adherent to their medications. Significant relationships were found between medication adherence and age, gender, educational level, marital status, and monthly income. Aging less than 70 years, female gender, sufficient income, fewer illnesses, and medication number were significant predictors for medication adherence.&#x0D; Conclusion: The current study findings revealed that most rural older adults with chronic illnesses were non-adherent to their medications, with many influencing factors such as age, gender, educational level, monthly income, and illnesses and medication number. So, the study recommends the importance of developing strategies to improve medication adherence in community-dwelling older adults in rural areas.