Medication Regimen Complexity Index Scores Research Articles

Home Medication Regimen Complexity in Newly Diagnosed Pediatric Oncology Patients.

Parents of children newly diagnosed with cancer require specialized education to provide care for their child at home, including the management of complex medication regimens. To assess the complexity of home medication regimens in a cohort of newly diagnosed pediatric oncology patients. We inventoried and categorized all discharge medications for each patient and used the Medication Regimen Complexity Index (MRCI) to quantify the complexity of the prescribed medication regimens. We used logistic regression to identify patient sociodemographic and clinical characteristics significantly (P < .05) associated with higher medication burden (ie, higher total MRCI scores). The cohort consisted of 105 newly diagnosed pediatric oncology patients initially hospitalized between December 2016 and February 2019 (61.9% male, 65.7% non-Hispanic White, 65.7% leukemia or lymphoma; median [range] age at diagnosis, 7.1 [0.4-17.7] years; median [range] number of discharge medications, 9 [1-14]). The proportion of patients prescribed ≥1 medication in each pharmacologic category was as follows: antiemetics, 94.3%; antimicrobials, 93.3%; pain management, 88.6%; oral care, 86.7%; stool softeners/laxatives, 81.0%; gastrointestinal protectants, 60.0%; cancer-directed therapy, 51.5%, other supportive therapies, 49.5%, other, 27.6%. Characteristics associated with ≥ median (≥33.0) MRCI score included a diagnosis of leukemia or lymphoma (odds ratio, 2.7; 95% confidence interval, 1.1-6.6; P = .027; comparison: solid tumor) and older age (odds ratio, 1.1 per year; 95% confidence interval, 1.0-1.2; P = .020). Most children newly diagnosed with cancer are discharged with complex medication regimens that parents/caregivers must manage at home. Nurses can use these findings to develop tailored medication education plans for parents/caregivers of newly diagnosed pediatric oncology patients.

Impact of Home Medicines Review on medication regimen complexity

AbstractBackgroundPrevious studies on pharmacist‐led Home Medicines Review (HMR) have demonstrated positive associations of HMR and clinical outcomes. However, little is known about their impact on medication regimen complexity.AimInvestigate the impact of pharmacist‐led HMRs on simplifying medication regimen complexity using the Medication Regimen Complexity Index (MRCI).MethodA retrospective cohort study of 196 general practitioners (GPs) initiated HMRs, conducted over a period of 2 years (2020–2022) using two credentialed pharmacists in New South Wales, Australia. MRCI was used to measure the complexity at two separate time points, at baseline and following pharmacists' recommendations (assuming the GPs accepted all of the pharmacists' recommendations provided during the HMRs). The Wilcoxon signed‐rank test was used to determine the difference between the scores at baseline and after HMR. Ethical approval was granted by the University of Sydney Human Research Ethics Committee (Reference no: 2022/584) and the study conforms to the Australian National statement on the ethical conduct in human research.ResultsDuring the HMR service, pharmacists made a total of 792 recommendations (mean ± standard deviation [4.04 ± 2.3] per HMR), among which dosage and frequency adjustment, laboratory monitoring, and therapeutic monitoring were the most common, collectively accounting for almost half of the recommendations. The median MRCI score at baseline was 28.5 (interquartile range [IQR] 21.5–37.6) and following pharmacists' recommendations was 29 (IQR 21.9–37.1). The difference between the baseline and post‐HMR scores was not statistically significant.ConclusionOur study demonstrates the lack of significant reductions in medication complexity following HMRs as measured by the MRCI. However, these results need to be interpreted with caution as not all interactions with patients lead to a change in the MRCI score. Comprehensive examination of individual medication changes may provide more meaningful and clinically relevant inferences.

Medication Regimen Complexity and Patient-Centred Outcomes in Patients Undergoing Peritoneal Dialysis.

Although patients undergoing peritoneal dialysis (PD) typically have complex treatment needs, the effect of medication regimen complexity on patient outcomes has not been thoroughly evaluated. This study aims to quantify medication regimen complexity and evaluate patient-centred outcomes including medication adherence and its determinants in patients undergoing PD. This study combined a retrospective audit of baseline data with a prospective evaluation of patient-related outcomes among patients undergoing PD at a large metropolitan dialysis centre in Australia. Medication regimen complexity was assessed using the 65-item Medication Regimen Complexity Index (MRCI), while patient outcomes were evaluated with validated self-reported questionnaires, including the 4-item Morisky-Green-Levine Scale (MGLS), EQ-5D-5L and EQ VAS. A total of 131 patients participated [median age 67 (IQR 57-74) years]. Patients on PD were found to have complex medication regimens with an average MRCI score of 28.6 ± 11.4. Over half of the participants were deemed to be adherent to their prescribed medications as measured by the MGLS (n = 79; 60.3%). Male participants were more likely to be non-adherent to medications compared to female participants (OR 2.465; 95% CI 1.055-5.759). Participants with higher serum phosphate levels were 2.5 times more likely to report non-adherence to their medications (OR 2.523; 95% CI 1.247-5.104), while a higher health-related quality of life (HRQoL) was associated with medication adherence (OR 0.151, 95% CI 0.031-0.732). Patients on PD are prescribed complex medication regimens in addition to PD treatments that they perform at home. Patients on PD who were adherent to their medications had significantly better outcomes in terms of HRQoL and serum phosphate levels compared to non-adherent patients.

A Prospective Study of the Medication Regimen Complexity Index and Hospitalization Due to Adverse Drug Reactions Among People Living with HIV.

Background and Objective: The complexity of antiretroviral therapy (ART) regimens in people living with HIV (PLHIV) poses significant challenges for medication management, impacting adherence and overall health outcomes. The Medication Regimen Complexity Index (MRCI) is a tool that quantifies regimen complexity, yet its correlation with hospitalization rates and adverse drug reactions (ADRs) in PLHIV remains underexplored. Materials and Methods: This prospective study, which was conducted at a government-funded antiretroviral treatment center, investigated the relationships among MRCI scores, hospitalization due to ADRs, and the ADR rates in 285 PLHIV participants over 18 months. Results: The study revealed a significant association between higher baseline MRCI scores and hospitalization due to ADRs, with a threshold MRCI score of 8 indicating increased risk. There was no significant association between average MRCI scores and overall ADR rates or non-ADR-related hospitalizations. Conclusions: These findings emphasize the importance of monitoring medication regimen complexity in PLHIV, particularly in the context of preventing hospitalizations related to ADRs. Further research is needed to understand the multifactorial influences on ADR occurrence and to optimize ART regimens for better patient outcomes.

Polypharmacy, therapeutic inertia, and adherence of heart recipients to drug therapy

Heart transplantation remains the gold standard treatment for end-stage heart failure. Lifelong immunosuppressive and adjuvant therapy requires constant medical follow-up in order to optimize treatment regimens and increase the adherence of heart recipients to treatment.Objective: to study and adapt a method for systematic assessment of the complexity of treatment regimen using the MRCI index, and its link to long-term prognosis in heart recipients.Materials and methods. Results of the study were obtained by analyzing the data of heart recipients observed at the Consultative &amp; Diagnostic Department, Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center). The Medication Regimen Complexity Index (MRCI) was used to assess drug therapy. In our study, polypharmacy was defined as taking five or more medications, and high-risk polypharmacy was defined as the use of more than eight medications. The heart recipients were divided into two groups based on how many medications they received daily.Results. The study included patients observed at the Consultative &amp; Diagnostic Department, Shumakov Center from January 2008 to December 2017. The number of drugs taken by the patient at year 5 of follow-up was 9.2 ± 4.2. During the conducted data analysis, the mean total MRCI score was 48.72 ± 19.15 (from 32 to 70); medications used to treat comorbidities accounted for 42.9% of the total MRCI score, and immunosuppressive therapy accounted for 28.7%. The total MRCI score in the high-risk polypharmacy group was 58.49 ± 17.41; medications used to treat comorbidities accounted for 50.27% of the total MRCI score. The analysis revealed a correlation between the total MRCI score and the frequency of hospitalizations.Conclusions. Patient adherence to prescribed treatment is a predictor of favorable prognosis of event-free long-term survival, but low adherence and therapeutic inertness are associated with decreased quality of life, more frequent hospitalizations and higher risk of adverse events. With proper outpatient follow-up of this patient cohort, there were no significant differences in survival in the polypharmacy and high-risk polypharmacy group.

Development and assessment of an abbreviated medication regimen complexity index (the A-MRCI).

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Adaptation of the Medication Regimen Complexity Index (MRCI) for automation in an electronic medical record has the potential to improve medication optimization and patient outcomes. The purpose of this study was to develop and evaluate an abbreviated medication regimen complexity index (A-MRCI) and compare its associations with patient-level factors to those of the MRCI. The MRCI was modified via several rounds of review with an expert panel of clinical pharmacists and outcomes researchers. Medication data from 138 electronic health records were abstracted to calculate MRCI and A-MRCI scores for dosage form, dosing frequency, and additional directions. Comparison between indices was performed using inferential statistics for a 1-month sample of patients admitted to a cardiology or advanced heart failure service in 2017. A-MRCI scores were higher than MRCI scores (mean difference of 3.97, P < 0.0005; 95% CI, 2.21-5.71). A significant association was observed between the A-MRCI score and both length of stay (P = 0.0005) and polypharmacy (P < 0.0005), whereas an association between MRCI score and the patient-level factors examined was not demonstrated. On average, A-MRCI scores were higher and more likely to be associated with several patient-level factors. Internal analyses show the potential for integration into an electronic health record for automation. However, further exploration of the A-MRCI in a larger external validation sample is warranted.

Factors Associated with Hyperpolypharmacy and Complex Medication Regimens in Kidney Transplant Recipients.

Background: Kidney transplantation is considered the best modality for renal replacement therapy. The use of immunosuppressive therapy and pre-existing and newly developed comorbidities predispose these patients to the use of a large number of medications. (Hyper)polypharmacy is associated with worse adherence and negative outcomes. This study aims to explore the factors correlated with hyperpolypharmacy and complex medication regimens in kidney transplant recipients. Methods: This is a cross-sectional study of outpatient kidney transplant recipients. Collected data include demographic data, complete chronic medication lists, medical history, and graft function. Linear and logistic regression were used to identify factors associated with hyperpolypharmacy and complex medication regimens. Medication regimen complexity was quantified by the Medication Regimen Complexity Index (MRCI). Results: Overall, 224 kidney transplant recipients were included, with an average time since transplantation of 8 years. Hyperpolypharmacy was present in more than two-thirds of patients; the average number of different medications was 12; and the mean MRCI score was 21.4, ranging from 6 to 50. Hypertension was almost universally present, while other frequently prescribed medication groups were hypolipemics, medication for bone-mineral metabolism disorders, gout, and antihyperglycemics. Conclusions: Factors independently associated with hyperpolypharmacy and complex medication regimens were found to be age and graft function. Studies investigating interventions aimed at reducing medication complexity and increasing adherence should focus on older patients with worse graft function.

Medication regimen complexity and its impact on medication adherence in patients with multimorbidity at a comprehensive specialized hospital in Ethiopia.

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

Persistence in the Methadone Maintenance Program and Its Relationship with the Medication Regimen Complexity Index in Opioid-Dependent Patients.

It has been shown that the Medication Regimen Complexity Index (MRCI) is a useful and reliable tool for calculating the complexity of the pharmacotherapeutic regimen (CPR). Furthermore, a high MRCI is associated with lower adherence. However, the MRCI of opioid-dependent patients (ODP) has not been studied. The aim of this study is to calculate the Methadone Maintenance Program (MMP) persistence and the MRCI score in a ODP cohort. Second, to analyze its relationship and association with other variables. To accomplish this research, an observational study including adults with a confirmed diagnosis of opiate-dependency according to the DSM-5 in a MMP center was carried out. To define MMP-persistence, a group was created by the researchers who defined five weighted items according to their agreed importance. Our first contribution was to create a new definition of MMP-persistence. This study also identified age, comorbidities, and received methadone maintenance doses as successful predictors for MMP-persistence. We have also shown that the MRCI does not seem to be a useful tool to determine MMP-persistence, probably because there are multiple factors that influence it in addition to the CPR. It is necessary to continue searching for more precise selection and stratification tools for ODP to improve their persistence.

Effect of Multi-Dose Dispensing on Medication Regimen Complexity: A Real-World Study.

(1) Background: Older patients frequently require dosing aids, such as multi-dose medication dispensing (MMD) when they experience medication regimen complexity (MRC) with increased drug use. However, the evaluations of the efficacy of MMD alterations remain limited. (2) Methods: A total of 1120 patients were included in the study who were discharged from hospital during the study period of January to March 2019. The Medication Regimen Complexity Index (MRCI) score, a validated 65-item tool in Korea (MRCI-K), was used to quantify MRC. The original MRCI-K scores, representing the typical administration based on prescription information, were compared to recalculated MRCI-K scores measured following MMD during the hospital dispensing period. Differences in MRCI-K across the top four wards based on the numbers of discharge prescription medications were assessed, and the overall scores were categorized into quartiles to identify MMD's impact within each group. We confirmed the effect of MMD based on the patient's admission diagnosis depending on MRCI. (3) Results: The mean (standard deviation) of original MRCI scores was 26.2 (13.4), which decreased to 18.9 (8.8) after applying MMD. The decrease in MRCI scores after MMD was statistically significant in all four wards, with the Orthopedic Surgery ward showing the biggest decrease. The patients with MRCI scores in the highest quartile group demonstrated the greatest improvement as a result of the implementation of MMD. Respiratory diseases exhibited the highest baseline MRCI scores due to formulation complexity, and ear, nose, and throat patients demonstrated the most significant reduction in MRC after MMD, depending on the diagnostic criteria at administration. (4) Conclusions: We confirmed the reduction in MRC after applying MMD, as a significant decrease in MRCI-K scores. This study highlights the need to deliver effective pharmacist-led services to identify patients who would benefit from MMD.

Association between medication complexity and follow-up care attendance: insights from a retrospective multicenter cohort study across 1,223 Chinese hospitals.

Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently face substantial medication burdens. Follow-up care on medication management is critical in achieving disease control. This study aimed to analyze the complexity of COPD-specific medication and determine how it impacted patients' attendance on follow-up care. This multicenter study includes patients with COPD from 1,223 hospitals across 29 provinces in China from January 2021 to November 2022. The medication Regimen Complexity Index (MRCI) score was used to measure COPD-specific medication complexity. The association between medication complexity and follow-up care attendance was evaluated using the Cox Proportional Hazard Model. Among 16,684 patients, only 2,306 (13.8%) returned for follow-up medication management. 20.3% of the patients had high complex medication regimen (MRCI score >15.0). The analysis revealed that compared to those with less complex regimens, patients with more complex medication regimens were significantly less likely to attend the follow-up medication care, with a Hazard Ratio (HR) of 0.82 (95% Confidence Interval [CI], 0.74-0.91). Specifically, patients with more complex dosage forms were 51% less likely to attend the follow-up care (95% CI, 0.43-0.57). This pattern was especially marked among male patients, patients younger than 65 years, and those without comorbid conditions. Higher medication complexity was associated with a decreased likelihood of attending follow-up care. To promote care continuity in chronic disease management, individuals with complex medication regimens should be prioritized for enhanced education. Furthermore, pharmacists collaborating with respiratory physicians to deprescribe and simplify dosage forms should be considered in the disease management process.

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.

Exploring the Impact of Medication Regimen Complexity on Health-Related Quality of Life in Patients with Multimorbidity

Background. Patients with multiple chronic conditions often have complex medication regimes which negatively impact their health-related quality of life (HRQoL), and there is limited evidence on this topic, particularly from the resource limiting set-up. Hence, this study is aimed at assessing the impact of medication regimen complexity on HRQoL in patients with multiple chronic conditions at a university hospital in Ethiopia. Method. A cross-sectional study was conducted on adult patients who had at least two long-term diseases and were already receiving medical therapy for the relevant disorders. The validated 65-item Medication Regimen Complexity Index (MRCI) and the EuroQol-5-Dimensions-5-Levels (EQ-5D-5L) instruments were used to assess MRC and HRQoL, respectively. The Welch test for unequal variance and Fisher’s exact test were used to assess the impact of different variables on HRQoL. Results. The study surveyed 416 participants, with a 98.3% response rate, the majority of whom were female (n = 267, 64.2%) and had two chronic conditions (n = 215, 51.7%). About 46.4% of patients were taking five or more medications, with a significantly higher proportion at the high regimen complexity level ( P = 0.001 ). The average MRCI score was 9.73 ± 3.38, indicating a high level of complexity. Patients with high MRCI scores reported more problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was a negative correlation between the MRCI score and HRQoL as measured by the EQ-5D-Index (r = −0.175; P &lt; 0.001 ) and the EuroQol-Visual Analogue Scale score (r = −0.151; P = 0.002 ). In addition, there was a statistically significant difference in the mean EQ-5D-Index ( P = 0.001 ) and EQ-VAS scores ( P = 0.001 ) across low, medium, and high MRCI levels. Conclusion. Medication regimen complexity was prevalent among patients with multimorbidity and was associated with a decrease in HRQoL. Therefore, interventions addressing medication-related issues should be a priority to improve the well-being of patients with multiple chronic conditions.

Assessment of Medication Regimen Complexity of COPD Regimens in Individuals Visiting Community Pharmacies.

Non-adherence is common and linked to poor COPD outcomes. Medication Regimen Complexity Index (MRCI) scores affect other disease outcomes. Little is known about the implications of MRCI scores in COPD. Secondary analysis was done to calculate MRCI scores assessing relationship to symptoms, COPD severity and health literacy (HL) to identify potential interventions to optimize adherence. Secondary analysis was conducted of cross-sectional, non-randomized survey data. Participants with self-reported COPD completed a survey of demographics, exacerbations, symptoms (COPD Assessment Test (CAT)), and self-reported COPD regimens. COPD severity was classified into Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD categories using exacerbation history and CAT. CAT scores were categorized as low (<10), high (>10) and very high (>20). A 1-year proportion of days covered (PDC) was calculated. A MRCI calculator scored regimens (primary endpoint). Published cut-off points were used to categorize MRCIs as low (≤4), medium (5-8) and high (>8) and inhaled device polypharmacy (IDP) as ≥3 devices. Risk for low HL was assessed using a Single Item Literacy Screener. Descriptive and Chi-squared statistics were used. Participants' (N = 709) PDC for 1 maintenance medicine averaged 0.43 ± 0.37; 28.7% were adherent (PDC ≥ 80%). CAT scores were very high in 54.6% and high in 35.8%. Distribution of GOLD categories were A (6%), B (35%), C (4%) and D (55%). High, medium and low MRCI were 85%, 14% and 9%, respectively. Mean devices per regimen was 2.05 ± 0.8; IDP was 28%. MRCI and IDP increased with worsening CAT scores and COPD severity per GOLD category (p<0.05), but not low HL. MRCI scores for COPD regimens increased with COPD severity and symptoms. Overall adherence was low despite high symptom scores; high MRCI scores could contribute. All COPD medication classes are available in multiple devices, combinations, and daily formulations; there is potential to simplify regimens. Prospective studies are needed to evaluate if interventions minimizing MRCI scores improve adherence and COPD outcomes.

Implications of the medication regimen complexity index score on hospital readmissions in elderly patients with heart failure: a retrospective cohort study

BackgroundThe likelihood of elderly patients with heart failure (HF) being readmitted to the hospital is higher if they have a higher medication regimen complexity index (MRCI) compared to those with a lower MRCI. The objective of this study was to investigate whether there is a correlation between the MRCI score and the frequency of hospital readmissions (30-day, 90-day, and 1-year) among elderly patients with HF.MethodsIn this single-center retrospective cohort study, MRCI scores were calculated using a well-established tool. Patients were categorized into high (≥ 15) or low (< 15) MRCI score groups. The primary outcome examined the association between MRCI scores and 30-day hospital readmission rates. Secondary outcomes included the relationships between MRCI scores and 90-day readmission, one-year readmission, and mortality rates. Multivariate logistic regression was employed to assess the 30- and 90-day readmission rates, while Kaplan-Meier analysis was utilized to plot mortality.ResultsA total of 150 patients were included. The mean MRCI score for all patients was 33.43. 90% of patients had a high score. There was no link between a high MCRI score and a high 30-day readmission rate (OR 1.02; 95% CI 0.99–1.05; p < 0.13). A high MCRI score was associated with an initial significant increase in the 90-day readmission rate (odd ratio, 1.03; 95% CI, 1.00-1.07; p < 0.022), but not after adjusting for independent factors (odd ratio, 0.99; 95% CI, 0.95–1.03; p < 0.487). There was no significant difference between high and low MRCI scores in their one-year readmission rate.ConclusionThe study’s results indicate that there is no correlation between a higher MRCI score and the rates of hospital readmission or mortality among elderly patients with HF. Therefore, it can be concluded that the medication regimen complexity index does not appear to be a significant predictor of hospital readmission or mortality in this population.

RWD112 The Medication Regimen Complexity Index Score As an Indicator of Racial Health Disparities in Clinical Outcomes

Obtaining initial medication history at admission can significantly influence clinical outcomes. Medication regimen complexity index (MRCI) scores highlight the differential clinical burden among races exacted by inaccurate medication errors. In this study, we evaluated racial disparities that stem from using MRCI for the prediction of inpatient outcomes.

Medication Regimen Complexity Index Score at Admission as a Predictor of Inpatient Outcomes: A Machine Learning Approach

In the intensive care unit, traditional scoring systems use illness severity and/or organ failure to determine prognosis, and this usually rests on the patient's condition at admission. In spite of the importance of medication reconciliation, the usefulness of home medication histories as predictors of clinical outcomes remains unexplored. A retrospective cohort study was conducted using the medical records of 322 intensive care unit (ICU) patients. The predictors of interest included the medication regimen complexity index (MRCI) at admission, the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Sequential Organ Failure Assessment (SOFA) score, or a combination thereof. Outcomes included mortality, length of stay, and the need for mechanical ventilation. Machine learning algorithms were used for outcome classification after correcting for class imbalances in the general population and across the racial continuum. The home medication model could predict all clinical outcomes accurately 70% of the time. Among Whites, it improved to 80%, whereas among non-Whites it remained at 70%. The addition of SOFA and APACHE II yielded the best models among non-Whites and Whites, respectively. SHapley Additive exPlanations (SHAP) values showed that low MRCI scores were associated with reduced mortality and LOS, yet an increased need for mechanical ventilation. Home medication histories represent a viable addition to traditional predictors of health outcomes.

Associations of medication regimen complexity with medication adherence and clinical outcomes in patients with chronic obstructive pulmonary disease: a prospective study.

High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge. Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities. Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7-13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52-0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57-0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27-2.11) and readmission (OR, 1.57; 95% CI, 1.17-2.10). MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission. ClinicalTrials.gov identifier: NCT02657525.

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.