Medication Regimen Complexity Index Research Articles

Simplification of medication regimens ñ a novel aspect of pharmaceutical care in hospital

BackgroundComplex medication regimens may cause non-adherence. It is not known to which extent regimens can be simplified by using combination and sustained release drugs and whether such simplifications ‘survive’ in...

Differences in Complexity of Discharge Medication Regimens between Men and Women Discharged from Acute Care to Home following Total Joint Arthroplasty

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

Assessing the complexity of medicine regimens – A pilot study

Complexity of medication regimens may adversely affect adherence and treatment outcome. The aim of this study was to assess the complexity of medication regimens. In this retrospective study, complexity of the medication regimens for outpatients was assessed using the medication regimen complexity index (MRCI). The correlation between medication complexity and the parameters of age, gender, underlying disorder and the number of medications were determined. Significant parameters impact on medication complexity were found to be age and number of medications. Therefore older patients, as well as patients taking several medications, should be monitored for compliance and adherence must be emphasized. Key words: Medication, complexity, adherence, treatment, regimens.

Quantifying home medication regimen changes and quality of life in patients receiving nocturnal home hemodialysis

Medication regimen simplification may improve adherence in end-stage kidney disease. The effect of nocturnal home hemodialysis (NHHD) on medication burden is unknown. A retrospective pilot study of NHHD patients was conducted. Medication information was collected at baseline, NHHD start, and at 3, 6, 12, 18, and 24 months. SF-36 scores were collected at baseline, 6, 12, and 24 months. The number of medications, pill burden, and number of administrations per day were determined. Medication Regimen Complexity Index was used at each time point as a comparator. Medications for anemia, mineral and bone disorders (MBD), cardiovascular (CV) disease, infection, and vitamins were analyzed for number of medications and pill burden. Thirty-five patients were included. Patients used 10.5 ± 4.4 medications at baseline and 11.8 ± 4.7 at the end of the study (P=NS). Regarding the number of medications, anemia medications, anti-infectives, and vitamins increased; MBD and CV medications decreased by the end of the study. Total pill burden did not change over 24 months, nor did anemia pill burden. Mineral bone disorder and CV pill burden decreased, and vitamins and anti-infective pill burden increased. Daily medication administration times decreased significantly from 5.0 ± 1.5 to 3.6 ± 1.5 by 24 months. Switching to NHHD was associated with a significant increase in Medication Regimen Complexity Index at 24 months (P<0.05). SF-36 scores increased significantly once patients began on NHHD. No measure of medication regimen complexity was correlated with the SF-36 score. Medication burden changes over time after starting NHHD. It is unknown what effect NHHD has on adherence or medication costs, and warrants further study in a prospective comparative investigation.

Effects of a pharmacotherapy follow-up in community pharmacies on type 2 diabetes patients in Brazil

To evaluate the effects of pharmacotherapy follow-up (PF) on metabolic control and clinical outcomes in type 2 diabetic patients. Six community pharmacies (4 intervention and 2 control) in the Curitiba metropolitan region (Brazil). Glycosylated Haemoglobin A1 (HbA1) and fasting capillary glycaemia. We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006. Pharmacotherapy follow-up was applied only to patients in the intervention group. Of the 161 patients enrolled, 96 completed the study (50 intervention and 46 control). The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes (2.3/patient [SD = 1.6]). The majority of detected problems were related to the ineffectiveness of pharmacotherapy (68.1%). Relative to the control group, the intervention group exhibited greater glycosylated haemoglobin (HbA1) reduction (-2.2% [95%CI -2.8%:-1.6%] vs. -0.3 [95% CI -0.8:0.2]; P < 0.001) and greater fasting capillary glycaemia reduction (-20.1 mg/dl [95% CI -31.9 mg/dl:-8.3 mg/dl] vs. 4.3 mg/dl [95% CI -13.4 mg/dl:22.2 mg/dl]; P = 0.022). These differences persisted after adjustment for baseline values. There were no significant differences in any other clinical measures between the groups. There were also no significant changes in the number of medications and treatment regimens between groups, with the exception of the percentage of patients undergoing lipid lowering treatment, which increased in the intervention group from 16% to 24% (P = 0.018). The initial medication regimen complexity index (MRCI) in the intervention group was 15.5 (SD = 7.8, range 4-40.5), and it decreased by 1.2 units (SD = 5.9) after 12 months (P = 0.149). PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity.

Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCI‐D)

Several factors contribute to the complexity of pharmacotherapeutic regimens, like the total number of medications to be taken, the number of dosage units to take at a time, dosage frequency, as well as specific directions concerning the administration. The Medication Regimen Complexity Index (MRCI) is a validated instrument developed in English for the measurement of the complexity of a given pharmacotherapeutic regimen. Translation of the MRCI into German and evaluation of the translated instrument (MRCI-D) in order to make it more easily accessible for use in German practice and research. The process of validation included the translation of the English version to German, back-translation into English, comparison of the back-translated and the original versions, pre-tests, and pilot-testing of the German version by three raters using 20 medication regimens for inpatients. The subsequent psychometric evaluation included the calculation of inter-rater and test-retest reliability, as well as the assessment of convergent validity. The number of medications correlated highly and statistically significantly with the MRCI-D score (0.91, P < 0.001), indicating sufficient convergent validity of the instrument. Both inter-rater and test-retest reliability were very high (intraclass correlation coefficients above 0.80 in all cases). Our results demonstrate that the German version of the MRCI reflects the complexity of therapeutic regimens with similar validity and reliability as the established English version. Thus, it may be a valuable tool to analyse therapeutic regimens in both clinical practice and science.

Association between drug prescribing and quality of life in primary care

To evaluate quality of life among patients of Family Health Strategy Units and how it relates to the prescribing complexity and to the number of psychotropic medications prescribed, including adjustments for sociodemographic characteristics. Family Health Strategy Units in a municipality in the Brazilian state of Rio Grande do Sul. Cross-sectional study using face-to-face interviews and prescribing analysis among users of Family Health Strategy Units. Patients were recruited by consecutive sampling. Multiple linear regression models were fitted to the different domains of quality of life in the WHOQOL-Bref questionnaire. The response rate for the patients who completed the interview was 97%. The prescribed medication data and sociodemographic characteristics of the sample were included as covariates. Prescribing complexity was analyzed by means of the Medication Regimen Complexity Index. The assumptions in the estimated models were tested and the models were validated. Quality of life among patients of Family Health Strategy Units. At total, 336 patients answered the questionnaire. Through multiple linear regression, it was observed that higher prescribing complexity was associated with significantly low scores in the physical (-2.01, 95% CI = -2.89 to -1.35) and overall (-1.93, 95% CI = -2.81 to -0.99) quality of life domains. Greater amounts of psychotropic medications prescribed were associated with significantly low scores in the physical (-1.02, 95% CI = -1.29 to -0.56), psychological (-2.52, 95% CI = -3.15 to -1.65) and overall (-0.97, 95% CI = -2.06 to -0.33) domains of the interviewees' quality of life. The estimated models were adjusted for the sociodemographic characteristics of the sample and presented good predictive capacity. The evaluated aspects of the prescribed medication (complexity and presence of psychotropic medications) were associated with low scores in the physical, psychological and overall quality of life domains. This may be an intrinsic characteristic of the interviewed patients, like having the quality of life at such a low level before starting the treatment, that the medication could not improve it to normal levels. Also, it can be a demonstration of the ineffectiveness of these treatments within primary health care.

Pilot Testing of a Medication Self-Management Transition Intervention for Heart Failure Patients

This pilot study examined the impact of a hospital transition intervention for older adults (≥ 65 years of age) with heart failure (HF) to promote medication use self-management. Forty subjects, hospitalized with either primary or secondary HF, had a mean age of 76.9 ± 6.5 years; 65% were males. The majority of subjects (55%) had NYHA Class III HF. A prospective, repeated measures experimental design was used. Baseline and follow-up data (1- and 3-months after hospitalization) were obtained using the Medication Regimen Complexity Index, Brief Medication Questionnaire, Drug Regiment Unassisted Grading Scale, and Kansas City Cardiomyopathy Questionnaire. Using repeated measures analysis of covariance (ANCOVA), with baseline measures as covariates, the transition intervention group had higher levels of medication adherence (F(1,35) = 13.4, p < .001), self-efficacy for HF self-care (F(1,35) = 17.9, p < .001) and had significantly fewer HF related symptoms that impaired health related quality of life (F(1,35) = 9.1, p = .006).

Tradução e validação para o português do Medication Regimen Complexity Index

The complexity of pharmacotherapy is a result of a multiplicity of prescribed regimen factors, including the number of different drugs in the regimen, the number of dosage units per dose, the total number of prescribed doses per day and administration instructions. The Medication Regimen Complexity Index (MRCI) is a specific, reliable and valid tool used to measure the complexity of pharmacotherapy, originally developed in English language. Transcultural translation and validation of this tool into Brazilian Portuguese. A cross-sectional study was developed with 95 type-2 diabetes patients, receiving multiple medications. The validation process included translation into Portuguese, back-translation and pre-test of the tool, creating a new version called the Pharmacotherapy Complexity Index (PCI). The psychometric parameters were assessed, including convergent validity, discriminant validity and reliability (interclass and test-retest correlation). The complexity of pharmacotherapy measured by the MRCI-Brazil had an average score of 15.7 points (SD=8.36). MRCI-Brazil showed significant correlation with the number of medications (r=0.86; p<0.001) and age of patients (r=0.28, p=0.005). Interrater reliability analysis found an intra-class correlation (ICC) of 0.99 (p<0.001) and test-retest correlation was of 0.997 (p<0.001). The results have shown that the Brazilian version of the MRCI presents adequate validity and reliability, and may be useful in clinical practice and research involving the analysis of the drug regimen complexity.