Median Medication Regimen Complexity Index Research Articles

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.

Changes in medication regimen complexity index following medication-related hospital admissions: A retrospective single-centre study.

Medication-related hospitalisations present an opportunity for de-prescribing and simplification of medication regimens. The Medication Regimen Complexity Index (MRCI) is a tool for measuring the complexity of medication regimens. To evaluate whether MRCI changes following medication-related hospitalisations, and to evaluate the relationship between MRCI, length of stay (LOS) in hospital, and patient characteristics. A retrospective medical record review of patients admitted to a tertiary referral hospital in Australia for medication-related problems, January 2019 to August 2020. MRCI was calculated using pre-admission medication lists and discharge medication lists. There were 125 patients who met inclusion criteria. The median (IQR) age was 64.0 years (45.0-75.0) and 46.4% were female. Median MRCI decreased by 2.0 following hospitalisation: from median (IQR) 17.0 (7.0-34.5) on admission vs 15.0 (3.0-29.0) on discharge (p<0.001). Admission MRCI predicted LOS ≥2 days (OR 1.03, 95%CI 1.00-1.05, p=0.022). Allergic reaction-related hospitalisations were associated with lower admission MRCI. There was a decrease in MRCI following medication-related hospitalisation. Targeted medication reviews for high-risk patients (e.g., those with medication-related hospitalisations) could further reduce the burden of medication complexity following discharge from hospital and possibly prevent readmissions.

Evaluation of health literacy and medication regimen complexity index among patients with human immunodeficiency virus infection: A single-Centre, prospective, cross-sectional study

BackgroundA limited number of studies have explored the association between health literacy (HL) and health outcomes. Effectively managing HIV infection expects from the patients the ability to seek medical help, understand the instructions provided by the healthcare professionals, and adhere to the treatment plans. This study aimed to evaluate the HL and medication regimen complexity index (MRCI) among people living with HIV and determine the associated factors. MethodsThis was a prospective, cross-sectional study. Each study participant was assessed using the HIV literacy test (HIV-LT). The complexity of the prescribed drug regimen was measured using MRCI. Changes in HL and MRCI with age, gender, and educational status of the individual were assessed. The presence of any correlation between HL and MRCI scores was assessed using Spearman's correlation coefficient test. ResultsOf the 285 patients with HIV infection studied, 51.6% were males and 48.4% were females. The median HIV-LT score was 3 (out of 10) (interquartile range [IQR], 0–6), and the median MRCI score was 8 (6–12). A statistically significant increase in the HL scores based on the educational status of the participants was seen (x2 = 87.324, p < 0.001). ConclusionOur study reveals that the majority of the HIV-infected patients studied had inadequate HL as measured using the HIV-LT tool. Those with poor HL did not receive more number of drugs as compared with those with higher HL. Strengthening the counselling and supportive care in patients with HIV, particularly among those with poor HL, is necessary. Clinical trial registrationCTRI/2019/06/019609.

Evaluation of Hospital Discharge Prescriptions in the Elderly and Younger Adults Using the Medication Regimen Complexity Index.

Advances in the clinical management of diseases have been accompanied by increasing complexity of treatment regimens. The complexity of medication regimen is of concern for patients as well as doctors as it may adversely affect patient compliance and treatment outcomes. It may result in medication errors, increased utilization of health resources owing to a reduction in treatment effectiveness, and increased risk of therapeutic failure. This study aimed to assess the complexity of medication regimen prescribed to patients on hospital discharge using the medication regimen complexity index (MRCI). A cross-sectional, descriptive study was conducted. Hospital discharge prescriptions written for patients discharged from the General Medicine wards of a tertiary care teaching hospital in South India were scored for their complexity using MRCI. The correlation of age and gender with the MRCI scores was also assessed. Patients ≥60 years of age were considered elderly. The median MRCI score for 563 prescriptions studied was 14 (Interquartile range, 9-21). Elderly patients received a significantly more complex medication regimen compared with younger patients (p < 0.001) at the time of hospital discharge. Gender variation was seen with higher MRCI scores in females, but this was not statistically significant in the elderly group. MRCI scores are significantly high in elderly patients at the time of hospital discharge. Although a strong correlation is seen between the number of medications and the MRCI score, the latter helps to distinguish regimen complexity between prescriptions with the same number of medications.

The impact of residential medication management reviews (RMMRs) on medication regimen complexity

ABSTRACTObjectives: The primary objective of this study was to investigate the impact of RMMRs on medication regimen complexity, as assessed by a validated measure.Methods: Retrospective analysis of RMMRs pertaining to 285 aged care residents aged ≥ 65 years in Sydney, Australia. Medication regimen complexity was measured using the Medication Regimen Complexity Index (MRCI) at baseline, after pharmacists’ recommendations (assuming that all of the pharmacists’ recommendations were accepted by the General Practitioner (GP)), and after the actual uptake of pharmacists’ recommendations by the GP. Differences in the regimen complexity was measured using the Wilcoxon sign rank test.Results: Pharmacists made 764 recommendations (average 2.7 recommendations per RMMR), of which 569 (74.5%) were accepted by GPs. The median MRCI at baseline in the sample was 25.5 (IQR = 19.0–32.5). No statistically significant differences were demonstrated in the MRCI scores after pharmacists’ recommendations (p = 0.53) or after GPs’ acceptance of these recommendations (p = 0.07) compared to the baseline.Conclusion: Our study revealed high acceptance of pharmacists’ recommendations by GPs. This suggests that RMMRs are useful for identifying and resolving drug-related issues among residents of ACFs. However, our study failed to show a significant effect of RMMRs in reducing the medication regimen complexity, as measured by the MRCI. Further studies are needed to establish the association of medication regimen complexity and clinical outcomes in residents of ACFs.

The association between polypharmacy and medication regimen complexity and antibiotic use in bronchiectasis

Background Polypharmacy is associated with an increased risk of adverse drug events, inappropriate prescribing and medication errors. People with bronchiectasis have frequent pulmonary exacerbations that require antibiotic therapy. Objective This study aimed to measure polypharmacy and medication regimen complexity in bronchiectasis patients and to explore associations between these factors and oral and intravenous (IV) antibiotic use for suspected pulmonary exacerbations. Setting Patients were sampled from the Regional Bronchiectasis Clinic at the Belfast Health and Social Care Trust, Northern Ireland. Method Data on medicines were collected from patients’ records and used to measure polypharmacy using three thresholds (≥ 4, ≥ 10, and ≥ 15 medicines’). Medication regimen complexity was calculated using the medication regimen complexity index (MRCI). Data analysis investigated differences in outcomes across polypharmacy thresholds and correlations with MRCI. Main outcome measure Primary outcomes were prescriptions for oral antibiotics and IV antibiotics, in the past 6 months and 2 years, respectively. Results Over three-quarters of the sample (N = 95) were prescribed ≥ 4 medicines (n = 74; 77.9%), 31 patients were prescribed ≥ 10 medicines (33.0%), and 12 patients (12.8%) were prescribed ≥ 15 medicines. The median MRCI was 26. Patients prescribed ≥ 10 medicines were over three times more likely to have had an IV antibiotic in the past 2 years (adjusted odd ratio 3.44, 95% confidence intervals 1.15–10.31). Conclusion There were significant differences in all outcomes across the ‘≥ 10 medicines’ threshold. MRCI was positively correlated with oral and IV antibiotic usage. These findings also suggest a possible link between polypharmacy and medicines regimen complexity, and poorer outcomes.

Electronic Medication Regimen Complexity Index at admission and complications during hospitalization in medical wards: a tool to improve quality of care?

Adverse events during hospitalization are a major worry considering their frequency and their burden. Many could be avoided by immediate identification of at-risk patients at admission and adapted prevention. The complexity of a patient's medication regimen immediately available at admission is a good indicator of the complexity of the patient's condition. This study aims to determine whether the electronic Medication Regimen Complexity Index (MRCI) at admission is associated with complications during hospitalization. We performed a multilevel logistic regression model, adjusted for age and sex. Premier Perspective™ database, a clinical and financial information system from 417 US hospitals. Adults hospitalized for more than 3 days in a medical ward and included in Premier's Perspective™ database for 2006. Multilevel logistic regression. Association of the MRCI and complications during hospitalization, defined as in-hospital death, hospital-acquired infection, pressure ulcers; and need for highly technical healthcare, identified as the secondary introduction of catecholamines. In total, 1 592 383 admissions were included. The median MRCI at admission was 13 [interquartile range: 9-19]. The higher the MRCI, the higher the adjusted odds ratio of the following: in-hospital mortality, hospital-acquired infections, pressure ulcers and the secondary introduction of catecholamines. Our results suggested that the MRCI at admission was correlated with patient complexity, independent of age. Considering that patients with complex conditions pose a heavier workload for staff, measuring MRCI at admission could be used to allocate resources in medical wards at an institutional level. The MRCI might be a useful tool to assess the management of care.

Treatment burden, clinical outcomes, and comorbidities in COPD: an examination of the utility of medication regimen complexity index in COPD

BackgroundCOPD patients are often prescribed multiple medications for their respiratory disease and comorbidities. This can lead to complex medication regimens resulting in poor adherence, medication errors, and drug–drug interactions. The relationship between clinical outcomes and medication burden beyond medication count in COPD is largely unknown.ObjectivesThe aim of this study was to explore the relationships of medication burden in COPD with clinical outcomes, comorbidities, and multidimensional indices.MethodsIn a cross-sectional study, COPD patients (n=222) were assessed for demographic information, comorbidities, medication use, and clinical outcomes. Complexity of medication regimens was quantified using the validated medication regimen complexity index (MRCI).ResultsParticipants (58.6% males) had a mean (SD) age of 69.1 (8.3) years with a postbronchodilator forced expiratory volume in 1 second % predicted of 56.5 (20.4) and a median of five comorbidities. The median (q1, q3) total MRCI score was 24 (18.5, 31). COPD-specific medication regimens were more complex than those of non-COPD medications (median MRCI: 14.5 versus 9, respectively; P<0.0001). Complex dosage formulations contributed the most to higher MRCI scores of COPD-specific medications while dosing frequency primarily drove the complexity associated with non-COPD medications. Participants in Global Initiative for Chronic Obstructive Lung Disease quadrant D had the highest median MRCI score for COPD medications (15.5) compared to those in quadrants A (13.5; P=0.0001) and B (12.5; P<0.0001). Increased complexity of COPD-specific treatments showed significant but weak correlations with lower lung function and 6-minute walk distance, higher St George’s Respiratory Questionnaire and COPD assessment test scores, and higher number of prior year COPD exacerbations and hospitalizations. Comorbid cardiovascular, gastrointestinal, or metabolic diseases individually contributed to higher total MRCI scores and/or medication counts for all medications. Charlson Comorbidity Index and COPD-specific comorbidity test showed the highest degree of correlation with total MRCI score (ρ=0.289 and ρ=0.326; P<0.0001, respectively).ConclusionIn COPD patients, complex medication regimens are associated with disease severity and specific class of comorbidities.

Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: a cross-sectional study.

The purpose of this study is to investigate the association between polypharmacy with health-related quality of life (HRQoL) and medication regimen complexity with HRQoL in residential aged care facilities (RACFs). A cross-sectional study of 383 residents from six Australian RACFs was conducted. The primary exposures were polypharmacy (≥9 regular medications) and the validated Medication Regimen Complexity Index (MRCI). The outcome measure was staff informant rated quality of life assessed using the Quality of Life Alzheimer's disease (QoL-AD) scale. Covariates included age, sex, Charlson's comorbidity index, activities of daily living, and dementia severity. Logistic quantile regression was used to characterize the association between polypharmacy and QoL-AD (model 1) and MRCI and QoL-AD (model 2). The median age of the 383 residents was 88years and 297 (78%) residents were female. In total, 63% of residents were exposed to polypharmacy and the median MRCI score (range) was 43.5 (4-113). After adjusting for the covariates, polypharmacy was not associated with either higher or lower QoL-AD scores (estimate -0.02; 95% confidence interval (CI) -0.165, 0.124; p = 0.78). Similarly, after adjusting for the covariates, MRCI was not associated with either higher or lower QoL-AD scores (estimate -0.0009, 95% CI -0.005, 0.003; p = 0.63). These findings suggest that polypharmacy and medication regimen complexity are not associated with staff informant rated HRQoL. Further research is needed to investigate how specific medication classes may impact change in quality of life over time.

Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies.

Medication reconciliation to identify discrepancies is a National Patient Safety Goal. Increasing medication number and complex medication regimens are associated with discrepancies, nonadherence, and adverse events. The Medication Regimen Complexity Index (MRCI) integrates information about dosage form, dosing frequency, and additional directions. This study evaluates the association of MRCI scores and medication number with medication discrepancies and commissions, a discrepancy subtype. This was a retrospective cohort study of a convenience sample of 104 ambulatory care patients seen from April 2010 to July 2011 within the Department of Veterans Affairs. Primary outcomes included any medication discrepancy and commissions. Primary exposures included MRCI scores and medication number. Multivariable logistic regression models associated MRCI scores and medication number with discrepancies. Receiver operating characteristic (ROC) curves provided discrepancy thresholds. For the 104 patients analyzed, the median MRCI score was 25 (interquartile range [IQR] = 14-43), and the median medication number was 8 (IQR = 5-13); 60% of patients had any discrepancy, whereas 36% had a commission. In adjusted analyses, patients with MRCI scores ≥25 or medication number ≥8 were more likely to have commissions (odds ratio [OR] = 3.64, 95% CI = 1.41-9.41; OR = 4.51, 95% CI = 1.73-11.73, respectively). The unadjusted ROC threshold for commissions was 36 for MRCI (sensitivity, 59%; specificity, 82%) and 9 for medication number (sensitivity 68%; specificity 67%). Patients with either MRCI scores ≥25 or ≥8 medications were more likely to have commissions. Given equal performance in predicting discrepancies, the efficiency and simplicity of medication number supports its use in identifying patients for intensive medication review beyond medication reconciliation.

Factors associated with medication regimen complexity in residents of long-term care facilities

BackgroundPolypharmacy and multimorbidity are highly prevalent in long-term care facilities (LTCFs). However, no previous research has investigated factors associated with medication regimen complexity in older residents living in LTCFs. ObjectiveTo investigate factors associated with medication regimen complexity in LTCFs. MethodsThis was a cross-sectional study across six LTCFs in South Australia. Medication, clinical and diagnostic data were extracted from each residents medication and medical record. Residents’ medication regimen complexity was quantified using the validated 65-item Medication Regimen Complexity Index (MRCI). Multinomial logistic regression analyses were used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for variables associated with high regimen complexity. ResultsThere were a total of 383 participants in the study. The mean age of the participants was 87.5 (standard deviation [SD]: 6.2) years. The median MRCI was 43.5 (range: 4–113). The median number of regular and as-needed medications was 13.0 (range: 1–30). Chronic pulmonary disease (OR: 5.10, 95% CI: 2.21–11.8), diabetes (OR: 3.22, 95% CI: 1.51–6.86) and congestive heart failure (OR: 3.13, 95% CI: 1.10–8.85) were associated with high regimen complexity. Independence in activities of daily living (ADLs) (OR: 0.72, 95% CI: 0.62–0.84) and diagnosed dementia (OR: 0.34, 95% CI: 0.17–0.67) were inversely associated with high regimen complexity. ConclusionLTCF residents are at-risk of high medication regimen complexity. Diabetes, congestive heart failure and chronic pulmonary diseases were associated with high regimen complexity, whereas dementia was inversely associated with high regimen complexity.