Complex Regimens Research Articles

Medication regimen complexity and its association with adherence and blood pressure control among hypertensive patients at selected hospitals of South Gondar Zone: A hospital based cross sectional study.

Despite the availability of effective antihypertensive medications, blood pressure (BP) control is suboptimal. High medication regimen complexity index (MRCI) is known to reduce adherence and may be the reason for poor BP control. However, there is no data in the present study areas. Hence, the aim of this study was to assess MRCI and its association with adherence and BP control among hypertensive patients at selected hospitals of South Gondar Zone. A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021 at selected hospitals of South Gondar Zone. Medication regimen complexity and adherence was evaluated using 65-item validated tool called MRCI (Text removed at time of retraction. See retraction notice for more information.). Multivariable logistic regression analysis was done to determine the association between predictive and outcome variables. About 3.3% of participants were classified as having high HTN specific MRCI whereas 34.75% of participants were classified as having high patient level MRCI. (Text removed at time of retraction. See retraction notice for more information.) Being illiterate, and having low HTN MRCI were more likely to have controlled BP in adjusted analyses. On the contrary, (Text removed at time of retraction. See retraction notice for more information.) not having health insurance, and having lower monthly income were less likely to have controlled BP. A considerable proportion of patients had high MRCI. Having low HTN MRCI was more likely to have controlled BP. Simplification of a complex medication regimen for patients with HTN should be sought by physicians and pharmacists to improve BP control.

The Association of Medication Complexity with COVID-19 Severity and its Impact on Pharmacotherapy Evaluation

Published on:August 2022Journal of Young Pharmacists, 2022; 14(3):322-326Original Article | doi:10.5530/jyp.2022.14.63 Authors: Yogendra Shrestha*, Rajesh Venkataraman, Jeet Bahadur Moktan, Sonakshi Mallikarjuna, Sindhu Shree Narayan, Manisha Hemmige Madappa, Priyanka Anekere SatyaDepartment of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, BG Nagara, Nagamangala, Karnataka, INDIA. Abstract: Background: Off-level medicines do not provide adequate health outcomes since there is insufficient efficacy and/or toxicity evidence. Offlevel medicines are more vulnerable to adverse drug reactions (ADRs), which are a prominent cause of morbidity and mortality. Objective of the study is to determine the relationship between the medication complexity and severity of COVID-19 and its impact on pharmacotherapy evaluation. Materials and Methods: A prospective, cross-sectional study was conducted in the COVID ward where medication complexity was assessed for all prescriptions on admission using the Medical Regimen Complexity Index’s guidelines and subjected to pharmacotherapy evaluation. Results: Overall, the patients spent an average of 7.55 ± 3.60 days in the hospital. Each prescription contained an average of 6.54 ± 2.51 drugs. Polypharmacy was found in 82.70% (263) of the prescriptions, while medication duplication was found in 17.29% (55), severe drug interactions accounted for 83.01% (264), and drug dosage adjustment was performed in 10.06% (32). The mean medication complexity was 26.86 ± 7. 58. When comparing medication complexity concerning the severity of COVID-19, we found that the average medication complexity score for mild was 24.62 ± 6.04, moderate was 31.65 ± 8.39, severe was 35.19 ± 6.81, and critical was 28.59 ± 8.60. we found a statistically significant positive correlation between the medical complexity and the hospital stay (P-value, 0.000), and there was an association between the medication complexity and the Covid-19 severity (p <0.001). Conclusion: The assessment of the medication complexity in routine pharmacotherapy evaluations could be beneficial in alerting potential risks, suggesting additional focus wherever required, and decreasing the financial burden by reducing hospital stay. It demonstrated an association between medication complexity and the severity of COVID-19.Keywords: Pharmacotherapy Evaluation, Medication Complexity, Drug Interaction, Polypharmacy, Medication Duplication, Dosage Adjustment.

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score.

Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population. This was a multicenter, observational cohort study. Twenty-eight ICUs in the United States. Adult ICU patients. Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively. A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient, -0.03; 95% CI, -0.04 to -0.02; p < 0.01) and intensity of interventions (β coefficient, -0.05; 95% CI, -0.09 to -0.01). Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

Determinants of multidrug-resistant tuberculosis in patients attending tertiary care teaching hospital, Vijayapur

Background: Multidrug-Resistant Tuberculosis (MDR-TB) has a more rapid course with poor treatment outcomes. Its treatment requires complex multiple 2nd line drug regimens which are longer, more expensive and more toxic Objectives: to identify factors associated with multidrug-resistant tuberculosis in order to identify high risk population who would develop MDR-TB and to suggest possible measures to be taken to reduce MDR-TB incidences in this region. Methods: A structured questionnaire in the vernacular language was used to collect information from study participants and was interviewed privately, and their names were not written on the questionnaire to ensure confidentiality. . Quantitative data were expressed as mean and standard deviation; the qualitative data were expressed as percentages and proportions Results: correlation of HIV positivity was observed in 9(15.3 %) patients. 14(23.7%) patients lived with TB patients earlier. Other diseases (including HIV) were present in 20(33.9%) patients. Excluding HIV, 6 had Diabetes Mellitus, 4 were chronic alcoholics and 1 had psychiatric illness. 12(20.3%) had a history of smoking. The previous TB treatment history of patients undergoing retreatment included site of TB infection being pulmonary in 41(69.5%) and only 2(3.4%) had extrapulmonary TB.27 (62.8%) patients were smear positive during first anti –TB treatment.

Pain management after microtia repair with costal cartilage: De-escalation and opioid use reduction

ObjectiveComplex and invasive postoperative pain regimens for microtia reconstruction with costal cartilage are often utilized. These generate added costs and invasiveness. We evaluated the effectiveness of a de-escalated pain regimen without use of invasive interventions. MethodsCase series of patients who underwent stage 1 microtia reconstruction with a modified Nagata/Firmin technique from 2017 to 2020 at a pediatric tertiary care hospital. Patients received intraoperative bupivacaine intercostal blocks and scheduled acetaminophen. Adjunct medications administered and pain scores (Wong-Baker FACES and FLACC-Face, Legs, Activity, Cry, Consolability) at intervals 2–72 h postoperatively were recorded. Narcotic use, peak and median pain scores, and length of stay were compared with published values. ResultsTwenty patients were included. Mean age of 12 and length of stay of 2.8 days. Average postoperative FACES scores between 0 and 72 h ranged between 0.7 and 4.0. The average peak pain score was 6.1 (±2.0). FLACC scores were low. Narcotics (0.59 ±0 .35 Morphine Milligram Equivalents/kg) were given to 17 patients. Compared to Shaffer et al. (paravertebral catheter-based infusion), total narcotics use (p = 0.03), peak pain (p = 0.0001), and length of stay (p = 0.001) were less. Compared to Woo et al. (intercostal catheter-based infusion), median pain scores at identical time intervals were lower (p = 0.04). ConclusionIntraoperative intercostal nerve blocks followed by scheduled, weight-based acetaminophen, adjunctive medications (ibuprofen and lidocaine patches), and rescue narcotics are effective in managing pain following microtia repair with autologous costal cartilage. It results in decreased narcotic usage, shorter length of stay, and lower pain scores compared to more complex regimens.

Evaluating the Medication Regimen Complexity Score as a Predictor of Clinical Outcomes in the Critically Ill.

Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06–1.19), 1.17 (1.1–1.24), and 1.21 (1.14–1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75–0.97] vs. 0.88 [0.76–0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71–0.93) and 0.87 (0.77–0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.

Screening for severe drug-drug interactions in patients with multiple sclerosis: A comparison of three drug interaction databases.

Background: Patients with multiple sclerosis (MS) often undergo complex treatment regimens, resulting in an increased risk of polypharmacy and potential drug-drug interactions (pDDIs). Drug interaction databases are useful for identifying pDDIs to support safer medication use. Objective: To compare three different screening tools regarding the detection and classification of pDDIs in a cohort of MS patients. Furthermore, we aimed at ascertaining sociodemographic and clinical factors that are associated with the occurrence of severe pDDIs. Methods: The databases Stockley’s, Drugs.com and MediQ were used to identify pDDIs by screening the medication schedules of 627 patients. We determined the overlap of the identified pDDIs and the level of agreement in pDDI severity ratings between the three databases. Logistic regression analyses were conducted to determine patient risk factors of having a severe pDDI. Results: The most different pDDIs were identified using MediQ (n = 1,161), followed by Drugs.com (n = 923) and Stockley’s (n = 706). The proportion of pDDIs classified as severe was much higher for Stockley’s (37.4%) than for Drugs.com (14.4%) and MediQ (0.9%). Overall, 1,684 different pDDIs were identified by at least one database, of which 318 pDDIs (18.9%) were detected with all three databases. Only 55 pDDIs (3.3%) have been reported with the same severity level across all databases. A total of 336 pDDIs were classified as severe (271 pDDIs by one database, 59 by two databases and 6 by three databases). Stockley’s and Drugs.com revealed 47 and 23 severe pDDIs, respectively, that were not included in the other databases. At least one severe pDDI was found for 35.2% of the patients. The most common severe pDDI was the combination of acetylsalicylic acid with enoxaparin, and citalopram was the drug most frequently involved in different severe pDDIs. The strongest predictors of having a severe pDDI were a greater number of drugs taken, an older age, living alone, a higher number of comorbidities and a lower educational level. Conclusions: The information on pDDIs are heterogeneous between the databases examined. More than one resource should be used in clinical practice to evaluate pDDIs. Regular medication reviews and exchange of information between treating physicians can help avoid severe pDDIs.

Development of a Low-Power IoMT Portable Pillbox for Medication Adherence Improvement and Remote Treatment Adjustment.

Patients usually deviate from prescribed medication schedules and show reduced adherence. Even when the adherence is sufficient, there are conditions where the medication schedule should be modified. Crucial drug–drug, food–drug, and supplement–drug interactions can lead to treatment failure. We present the development of an internet of medical things (IoMT) platform to improve medication adherence and enable remote treatment modifications. Based on photos of food and supplements provided by the patient, using a camera integrated to a portable 3D-printed low-power pillbox, dangerous interactions with treatment medicines can be detected and prevented. We compare the medication adherence of 14 participants following a complex medication schedule using a functional prototype that automatically receives remote adjustments, to a dummy pillbox where the adjustments are sent with text messages. The system usability scale (SUS) score was 86.79, which denotes excellent user acceptance. Total errors (wrong/no pill) between the functional prototype and the dummy pillbox did not demonstrate any statistically significant difference (p = 0.57), but the total delay of the intake time was higher (p = 0.03) during dummy pillbox use. Thus, the proposed low-cost IoMT pillbox improves medication adherence even with a complex regimen while supporting remote dose adjustment.

Treatment-Related Attributes of Diabetes Therapies and How People with Type 2 Diabetes Report Their Impact on Indicators of Medication-Taking Behaviors.

PurposeUnderstanding the treatment-related attributes influencing medication-taking behaviors in people with type 2 diabetes (T2D) is important for delivery of patient-centered care. This review aimed to identify and summarize studies in which people with T2D (PwD) directly indicated the treatment-related attributes associated with medication-taking behaviors or intentions.Materials and MethodsEMBASE and PubMed were searched for studies (Jan 2005–May 2021) reporting the link between PwD-expressed diabetes treatment-related attributes and the decision to initiate, adhere to, or discontinue a T2D medication. Eligible studies reported attributes associated with oral antidiabetes drugs or injectables (not insulin). Studies not explicitly exploring the link between attributes and indicators of behaviors (eg most discrete-choice experiments [DCE] and those interrogating electronic medical records or claims databases) were excluded, as were studies where the link between attribute and behavior came from anyone but the PwD.ResultsOf the 6464 studies identified, 16 were included. Studies were conducted across multiple countries; the USA was most represented (n = 8 studies). The impact of treatment attributes was described on indicators of initiation (n = 3), adherence (n = 12), and discontinuation (n = 4). Some studies evaluated multiple behaviors. PwD perspectives were solicited by structured questionnaires (n = 10), qualitative approaches (n = 4), or DCE explicitly exploring the link to medication-taking behaviors (n = 2). Closed- (n = 9) and open-ended questions (n = 7) were employed. Across studies, several factors including glycemic efficacy (n = 9), weight change (n = 9), dosing frequency (n = 9), hypoglycemia (n = 8), gastrointestinal adverse events (n = 8), regimen complexity (n = 6), route of administration (n = 3), and cardiovascular risk (n = 1) were reported as influencing behaviors, being motivators or barriers to initiation, adherence, or discontinuation.ConclusionSeveral attributes influence how PwD take their medications. Insights gained directly from PwD have the potential to assist stakeholders in making more informed, patient-centered, treatment decisions, thus choosing and managing medications that PwD are comfortable initiating and persisting with over the longer term.

Self-care and quality of life among men with chronic heart failure.

IntroductionChronic Heart Failure (CHF) involves a complex regimen of daily self-care behaviors: pharmacological therapy, symptom monitoring and lifestyle modifications. Patients with CHF may have a reduced health related quality of life (HRQoL) due to various physical and emotional symptoms. HRQoL may be improved through the use of self-care interventions.PurposeTo assess the level of self-care and quality of life among men with chronic heart failure.MethodsThe study was conducted among 80 men diagnosed with CHF (mean age 58 years). The study was cross-sectional. A self-administered questionnaire and analysis of medical records were used to collect baseline sociodemographic and clinical data. Self-care was assessed using the standardized European Heart Failure Self-care Behavior Scale- EHFScBS-9 and quality of life was assessed using the World Health Organization Quality of Life Bref.ResultsThe Patients in NYHA class II constituted the vast majority (71.25%), mean LVEF in the study group was 43.5%, and mean disease duration was 3 years. The most common comorbidities were ischemic heart disease (72.5%), hypertension (70%) and diabetes mellitus (60%). The most commonly reported non-pharmacological treatments for NS were fluid restriction (45%), moderate physical activity (42.50%) and daily weight control (41.25%). The EHFSc-9 questionnaire score averaged 50.31 points out of 100 possible (SD = 26.52). The mean score regarding perception of QoL was 2.78 points (SD = 0.91), and 40% of patients indicating poor perception of QoL. The mean score for self-rated Analysis of the results of the individual domains of the WHOQoL BREF questionnaire showed that patients rated their QoL best in the environmental domain (M = 13.28; SD = 3.11), then in the social domain (M = 12.81; SD = 2.71), and in the psychological domain (M = 12.8; SD = 3.2). In contrast, QoL in the physical domain was rated the lowest (M = 10.44; SD = 2.85). There was no significant correlation between quality of life and self-care (p > 0.05).ConclusionsMen with CHF have unsatisfactory self-care outcomes and low quality of life scores and are dissatisfied with their health. Strategies to improve selfcare and quality of life in this group are indicated.

Home Medication Regimens Increase in Complexity After Admission for Fall in the Older Trauma Patient.

Hospitalization for the older trauma patient is an opportunity to assess polypharmacy. We hypothesized that medication regimen complexity (RxCS) and pain medication prescriptions (PRxs) would increase in older home-going patients admitted for a fall. We retrospectively chart reviewed patients ≥45years old admitted for a fall at a level 1 trauma center who were discharged home with full medication documentation. RxCS was compared pre-admission and post-discharge with Wilcoxon signed-rank tests; opioid and non-opioid PRxs were compared with Fisher's exact test, α = .05. 103 patients met inclusion criteria; 58% were ≥65years old. RxCS (9 [.5-13] to 11 [4.5-15], P < .01) increased on discharge. Opioid PRx rates increased significantly in all age groups. Non-opioid PRx rates increased significantly for patients <65 but not for patients ≥65. Admission for a fall was associated with increases in RxCS, while PRx changes were age-dependent. Providers should recognize that admissions for older patients who fall after trauma are underutilized opportunities to address polypharmacy in high-risk patients.

Self-care behaviors of patients with implanted left-ventricular assist device in Israel: a comparative study before and during COVID-19 pandemic

Funding AcknowledgementsType of funding sources: None.Background/IntroductionLeft ventricular assist devices (LVADs) support the heart of patients with advanced heart failure. Following LVAD implantation, patients face a complex regimen of self-care behaviors including self-care maintenance, self-care monitoring and self-care management. During the COVID-19 pandemic, the self-care might be inadequate because of the disease occurrence as well as social constraints, transportation restrictions, social distancing, and psychosocial stress. Little is known on how comparable specific self-care behaviors are among LVAD-implanted patients before and during COVID-19 pandemic.PurposeTo describe and compare self-care behaviors among patients with an implanted LVAD in Israel before and during the COVID-19 pandemic and explore factors related to self-care behaviors change.MethodsA prospective observational cross-sectional study design. A convenience sample of 28 Israeli LVAD-implanted patients (mean age 62.4 ± 9, 86% male, 78.6% lived with a partner) completed an LVAD Self-Care Behavior Scale before (data collection: March, 2017- February, 2020) and again, following the onset of COVID-19 pandemic in Israel in March 2020 (data collection: April, 2020 – September, 2020). The patients responded to 33 statements about how they perform self-care behaviors on a 5-point Likert scale ranging from 1 (never) to 5 (always). Statistical analyses included paired t-test and one-way repeated measures ANOVA.ResultsAttending scheduled clinic visits (M=4.93) and keeping the exit site and the driveline clean and dry (4.89) were two highly prevalent behaviors that did not change during the COVID-19 pandemic. The significant decrease in adherence during the COVID-19 pandemic was found in checking and recording LVAD speed, flow, power and PI (Mbefore=3.88±1.48 vs Mduring=3.08±1.55, t=2.02, p=.05), checking INR (Mb=5.0±0 vs Md=4.78±.42, t=2.73, p=.01), and weighing daily (Mb=4.54±.71 vs Md=3.92±1.06, t=3.19, p<.01). Adherence to the following behaviors increased most prominently, but not statistically significantly: talking to an LVAD team when feeling sad or worried (Mb=3.13±1.65 vs Md=3.71±1.55, t=1.39, p=.18) and contacting the LVAD team in case of symptoms (Mb=4.52±.96 vs Md=4.80±.5, t=1.37, p=.18).Compared to patients with a partner, those without a partner tended to worsen their adherence to some of the self-care behaviors e.g. taking medicines as prescribed (Mb=5.00±0 and Md=5.0±0 vs Mb=5.0±0 and Md=4.6±.89, F=4.85, p=.04, respectively).ConclusionsPriorities in self-care behaviors among patients with implanted LVAD may differ before and during a pandemic. In several crucial behaviors in self-care maintenance and management (checking and recording LVAD and INR, and taking medicines) and self-care monitoring (daily weighing) the adherence decreased significantly. The current results may guide further research on identifying behaviors at risk of not being maintained in a time of emergency.

Real-world use and outcomes of dolutegravir-containing antiretroviral therapy in HIV and tuberculosis co-infection: a site survey and cohort study in sub-Saharan Africa.

IntroductionDolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use is complicated by a drug–drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug–drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co‐infection receiving dolutegravir or efavirenz.MethodsWithin the four sub‐Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015–2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.ResultsIn the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice‐daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice‐daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3–63.3%), switching ART regimen was 4.1% (95% CI: 2.6–6.2%) and loss to program/death was 23.4% (95% CI: 19.7–27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28–1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08–1.51).ConclusionsAt a programmatic level, dolutegravir was being widely prescribed in sub‐Saharan Africa for people with HIV and tuberculosis co‐infection with a dose adjustment for the drug–drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.

Multimorbidity among patients with digestive cancers patients in Chile: a nationwide database study

Multimorbidity, the presence of two or more chronic diseases in one individual, affects an increasing number of patients worldwide, creating one of the main challenges in global public health. Multimorbidity results in higher mortality, lower quality of life, and individual risks, such as polypharmacy and exposure to complex therapeutic regimens. In Chile, five of the top ten cancers with the highest mortality rates affect the digestive system. To our knowledge, this is the first study based on a national-wide database focused on multimorbidity in patients with cancer in Chile. Our objective was to characterise multimorbidity and establish the chronic diseases and combinations thereof that most contribute to multimorbidity in patients with digestive cancers in Chile. Hospital discharge data for this study were taken from a national database based on Diagnosis-Related Groups through International Classification of Diseases, 10th revision (ICD-10) codes. Multimorbidity was defined as the presence of two or more (from a list of 45 chronic diseases) in addition to digestive cancer. Frequencies of chronic diseases were calculated and the patterns of multimorbidity in patients with multimorbidity and in different digestive cancers were described. The hospital discharge records of 1 464 884 patients, with a total of 1 933 386 hospitalisation events (defined as admission and discharge from the hospital), were screened. Hospital admissions between Nov 1, 2018, and Dec 31, 2020 were considered. We found 18 678 patients aged 15 years or older and diagnosed with digestive cancers as per ICD-10 codes (colorectal [C18-C19.0, C20, and C21-C21.8], stomach [C16-C16.9], pancreatic [C25-C25.9], liver [C22-C22.4 and C22.7-C22.9], oesophageal [C15-C15.9], gallbladder and biliary tract cancers [C23-C24.9], or small intestine [C17]). 7861 (42·1%) of 18 678 patients had colorectal cancer, 5917 (31·7%) had stomach cancer, 1727 (9·2%) had pancreatic cancer, 1663 (8·9%) had liver cancer, 1162 (6·2%) had oesophageal cancer, 515 (2·8%) had gallbladder and biliary tract cancer, and 28 (0·1%) had small intestine cancer. We found that 9391 (50·3%) of all patients with digestive cancers were affected by multimorbidity (3770 [47·9%] of 7861 patients with colorectal cancer, 2860 [48·3%] of 5917 patients with stomach cancer, 903 [52·3%] of 1727 patients with pancreatic cancer, 1132 [68·1%] of 1663 patients with liver cancer, 516 [44·4%] of 1162 patients with oesophageal cancer, 284 [55·1%] of 515 patients with gallbladder and biliary tract cancer, and 14 [50·0%] of 28 patients with small intestine cancer). Frequency of multimorbidity increases with age. High blood pressure (in 8306 [44·5%] of 18678 patients), diabetes (in 4084 [21·9%] of 18678 patients), non-malignant thyroid disease (in 3773 [20·2%] of 18678 patients), anaemia (in 2653 [14·2%] of 18678 patients), and liver disease (in 2454 [13·1%] of 18678 patients) were the five most frequent chronic diseases identified. Chronic conditions affecting patients with cancer was highly variable with cancer type: for example, the diagnosis of diabetes was found to be more common in all patients diagnosed with liver cancer (594 [35·7%] of 1663) than in patients diagnosed with stomach cancer (1162 [19·1%] of 5917); the diagnosis of anaemia was more common in all patients diagnosed with stomach cancer (1096 [18·5%] of 5917) that in all patients diagnosed with oesophageal cancer (87 [7·5%] of 1162) or that in all patients diagnosed with gallbladder and biliary tract cancer (45 [8·7%] of 515); and the diagnosis of dementia (68 [13·2%] of 515) and thyroid disease (115 [22·3%] of 515) were more common in all patients diagnosed with gallbladder and biliary tract cancer than in patients with other digestive cancers. The most frequent multimorbidity pattern in all patients with digestive cancers was high blood pressure and diabetes (in 1308 [13·9%] of 9391 multimorbidity patients). This study is, to the best of our knowledge, the first characterisation of multimorbidity in Chilean patients with digestive cancers. The presentation of chronic diseases in patients with digestive cancers is heterogeneous and varies with the digestive organ affected by cancer. Protocols that include the evaluation of multimorbidity during primary and hospital care of patients with cancer need to be developed. Patient-centred approaches that can manage and respond to the needs of patients with complex health conditions while contributing to comprehensive care are necessary to improve outcomes in patients with cancer. National Agency for Research and Development (reference 21210439).

Using a Mechanical Lift at Home: Preparing family caregivers to use lifts for transfers.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

Home Oxygen Therapy: Assisting and educating caregivers and those receiving supplemental oxygen.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.

O-047 Can ovarian response be predicted and why would you want to know?

Abstract Since the early days, IVF has often been combined with ovarian stimulation. Starting the in viteo fertilization procedure with multiple oocytes, may compensate for suboptimal laboratory performance. This trend has developed during 4 decades into the development of extremely complex and expensive ovarian stimulation regimens, along with the widespread belief that the ‘more oocytes the better’ for IVF success rates. Moreover, ovarian response to standard stimulation varies greatly, and over-response is clearly linked to added side effects and health risks for women. Multiple studies emphasize that current standard IVF represents a very wasteful procedure, since only 1 out of 20 to 50 oocytes generated does result in a live birth. The concept of ‘the more oocytes the better’ is largely based on the observation that few oocytes are associated with poor clinical outcomes. However, generating few oocytes following maximal stimulation in conventional IVF is mostly due to diminished ovarian reserve, an intrinsic problem of the ovary unrelated to the extent of stimulation and clearly associated with poor outcomes. Increasing evidence suggests that few oocytes retrieved following mild stimulation do coincide with good IVF success rates. This difference is often ignored. It would be most important to reach a more broad scope consensus on the optimal number of oocytes to be retrieved for IVF, taking cost, patient discomfort, and safety into consideration next to clinical success rates. Subsequently, individualized stimulation regimens should be developed to reach the optimal response in the majority of women undergoing IVF. individual patient characteristics should be identified which are linked to ovarian response, such as female age, body weight, ovarian reserve biomarkers (like Anti-Mullerian hormone, and antral follicle count) soon to be complemented with genomic ovarian markers. In the current transition from mass medicine (the same treatment for all) to patient-tailored approaches, individualized ovarian stimulation based on robust markers would represent a true step forward giving rise to safer, simpler, and more cost-effective IVF with comparable success rates.

CO54 Medication Regimen Complexity in the Critical Care Unit: Association with Length of Stay, Need for Invasive Mechanical Ventilation, and ICU Mortality

Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and administration and has been associated with poorer critical care outcomes. To date, two scoring tools, Medication Regimen Complexity Index (MRCI) and Medication Regimen Complexity Intensive Care Unit (MRCICU) have been utilized. This study assessed the association between MRC scores and three outcomes of interest in an adult critical care setting: ICU length of stay (LOS), need for invasive mechanical ventilation (MV) and ICU mortality.

Review of Calcipotriene and Betamethasone Dipropionate Cream in the Treatment of Psoriasis.

To review the pharmacokinetics, efficacy, and safety of recently approved calcipotriene and betamethasone dipropionate (C-BD) cream. A literature review was conducted using MEDLINE (PubMed) and ClinicalTrials.gov from 2002 to mid-May 2022. Articles in English discussing the use of C-BD cream in the treatment of psoriasis were included. In 2 phase I trials, there was no phototoxic or photoallergic skin reaction at irradiated C-BD cream sites at baseline, 24 hours, 48 hours, and 72 hours postirradiation. In 2 phase III trials, after 8 weeks of treatment, more subjects treated with C-BD cream achieved Physician's Global Assessment treatment success (37.4%), compared to C-BD topical suspension (TS) (22.8%, P < 0.0001) and vehicle (3.7%, P < 0.0001). More subjects had greater mean percentage decline in Modified Psoriasis Area Severity Index (Trial 1: 52.9% and Trial 2: 64.6%), when compared to C-BD TS (Trial 1: 51.3%, P < 0.0001 and Trial 2: 56.4%, P < 0.0001) and vehicle (Trial 1: 22.9%, P < 0.0001 and Trial 2: 20.0%, P < 0.0001). Psoriasis has a multifactorial pathogenesis and topical treatments are considered first line. Poor adherence is a major hurdle in management; the combination of 2 separate first-line drugs may address this by decreasing the complexity of treatment regimens. A cream formulation can be preferred, and C-BD is now Food and Drug Administration (FDA) approved as one. Newly FDA-approved C-BD cream with novel polyaphron dispersion (PAD) technology provides a safe efficacious combination therapy for mild-to-moderate psoriasis which may be preferred by some patients.

Polypharmacy and medication regimen complexity in older patients with hemophilia or von willebrand disease: the M'HEMORRH-AGE study.

In older patients, multiple chronic conditions lead topolypharmacy which is associated with a higher risk of adverse drug events. Nowadays, the medication exposure of older patients with bleeding disorders has been poorly explored. The aim of this study was to assess the prevalence of polypharmacy and the medication regimen complexity in older community-dwelling patients with hemophilia or von Willebrand Disease (VWD). The M'HEMORRH-AGE study (Medication in AGEd patients with HEMORRHagic disease) is a multicenter prospective observational study. Community-dwelling patients over 65 years with hemophilia or VWD were included in the study. The rate of polypharmacy (use of 5 to 9 drugs daily) and excessive polypharmacy (use of 10 or more medications daily) was assessed. The complexity of prescribed medication regimens was assessed using the Medication Regimen Complexity Index (MRCI). Overall, 142 older community-dwelling patients with hemophilia (n = 89) or VWD (n = 53) were included (mean age: 72.8 (5.8) years). Prevalence of polypharmacy and excessive polypharmacy were 40.8% and 17.6%, respectively. The mean MRCI score was 16.9 (6.1). The mean MRCI score related to bleeding disorders medications was 6.9 (1.1). There was no significant difference between older hemophilia patients and VWD patients. The M'HEMORRH-AGE study showed that more than half of older community-dwelling patients were affected by polypharmacy. In addition, the high medication regimen complexity in this older population suggests that interventions focusing on medication review and deprescribing should be conducted to reduce polypharmacy with its negative health-related outcomes.