This study identified some health outcomes that may be influenced by medication regimen complexity: hospitalization, hospital readmission, and medication adherence were more prevalent, showing a significant association between MRCI increase and these health outcomes.

BackgroundPolypharmacy is a reality in long-term care facilities. However, number of medications used by the patient should not be the only predictor of a complex pharmacotherapy. Although the level of complexity of pharmacotherapy is considered an important factor that may lead to side effects, there are few studies in this field. The aim of this study was to evaluate the complexity of pharmacotherapy in residents of three long-term care facilities.MethodsA cross-sectional study was performed to evaluate the complexity of pharmacotherapy using the protocols laid out in the Medication Regimen Complexity Index instrument in three long-term care facilities in northeastern Brazil. As a secondary result, potential drug interactions, potentially inappropriate medications, medication duplication, and polypharmacy were evaluated. After the assessment, the association among these variables and the Medication Regimen Complexity Index was performed.ResultsIn this study, there was a higher prevalence of women (64.4%) with a high mean age among the study population of 81.8 (±9.7) years. The complexity of pharmacotherapy obtained a mean of 15.1 points (±9.8), with a minimum of 2 and a maximum of 59. The highest levels of complexity were associated with dose frequency, with a mean of 5.5 (±3.6), followed by additional instructions of use averaging 4.9 (±3.7) and by the dosage forms averaging 4.6 (±3.0).ConclusionsThe present study evaluated some factors that complicate the pharmacotherapy of geriatric patients. Although polypharmacy was implicated as a factor directly related to complexity, other indicators such as drug interactions, potentially inappropriate medications, and therapeutic duplication can also make the use of pharmacotherapy in such patients more difficult.

Twenty-nine articles (17 cross-sectional and 12 cohort) were included. The majority of the studies were conducted in Europe. Regarding the study durations, 3 to 18 months was necessary to perform the research. As for the sample characteristics, all the studies analyzed involved the older adults and included anywhere from 96 patients to 33,830,599 outpatient consultations. Of the variables analyzed, only polypharmacy presented a positive association with the use of PIDT. All meta-analysis studies showed high heterogeneity, indicating the lack of a methodological standardization of the studies included, among other factors.

A review based on personal experience and evidence of literature. Eur J Endocrinol 2005;153:723-735. 4. Randeva HS, Schoebel J, Byrne J et al. Classical pituitary apoplexy: Clinical features, management and outcome. Clin Endocrinol (Oxf) 1999;51:181-188. 5. Shimon I, Benbassat C, Hadani M. Effectiveness of long-term cabergoline treatment for giant prolactinoma: Study of 12 men. Eur J Endocrinol 2007;156:225-231. 6. Webster J, Piscitelli G, Polli A et al. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 1994;331:904-909. 7. Orrego JJ, Chandler WF, Barkan AL. Rapid re-expansion of a macroprolactinoma after early discontinuation of bromocriptine.To the Editor: Population aging is a worldwide phenomenon that has contributed to the growing number of residents in long-term care facilities (LTCFs). This elderly population has more symptoms and chronic diseases and uses more medications than younger people. Recently, the literature has shown the importance of multidisciplinary staff in the care of older adults. The active participation of the pharmacist is essential to the management of complex drug therapy regimens and the reduction of drug-related morbidity and mortality in this population. 1 Therefore, this review aimed at analyzing the research quality of pharmaceutical interventions in elderly residents of LTCFs. METHODSA search was conducted to identify intervention studies involving pharmacists in LTCFs. The Medline, Scopus, Scielo, and LILACS databases were reviewed from January 1988 to December 2008, using pharmacists, elderly, pharmaceutical services, multidisciplinary approach, nursing homes, and long-term care facilities as keywords.The subsequent screening process was performed in three stages. Titles and abstracts were compared with the following predefined inclusion criteria to determine the relevance of the theme: if the study was performed in a LTCF, if the study involved intervention, and if the intervention process involved the participation of a pharmacist. Studies that focused on intervention with a single medication (or medication group) or a specific disease and that were not conducted entirely in a LTCF were excluded, as were those that were not written in English or did not provide the full text.The studies that satisfied the inclusion criteria for data extraction were carefully examined regarding the following variables: scenario of the study, type of study, professionals participating in the intervention process, type of intervention used, and its results. RESULTSAt the end of the review, only seven articles met the specific inclusion criteria (Table 1). Five articles were controlled clinical trials, 2-6 only one of which was not randomized. 5 One of the articles was classified as longitudinal, with evaluation of the study group before and after interventions, 7 whereas another study did not describe its methodology. 8 In three of the seven studies, the pharmacist was the only provider in the int...

Background: Current evidence of the influence of the medication regimen complexity (MRC) on the patients’ clinical outcomes are not conclusive. Objective: To systematically and analytically assess the association between MRC measured by the Medication Regimen Complexity Index (MRCI) and clinical outcomes. Methods: A search was carried out in the databases Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science to identify studies evaluating the association between MRC and clinical outcomes that were published from January 1, 2004, to April 2, 2018. The search terms included outcome assessment, drug therapy, and medication regimen complexity index and their synonyms in different combinations for case-control and cohort studies that used the MRCI to measure MRC and related the MRCI with clinical outcomes. Odds ratios (ORs), hazard ratios (HRs), and mean differences (WMDs) were calculated, and heterogeneity was assessed using the I2 test. Results: A total of 12 studies met the eligibility criteria. The meta-analysis showed that MRC is associated with the following clinical outcomes: hospitalization (HR = 1.20; 95% CI = 1.14 to 1.27; I2 = 0%) in cohort studies, hospital readmissions (WMD = 7.72; 95% CI = 1.19 to 14.25; I2 = 84%) in case-control studies, and medication nonadherence (adjusted OR = 1.05; 95% CI = 1.02 to 1.07; I2 = 0%) in cohort studies. Conclusion and Relevance: This systematic review and meta-analysis gathered relevant scientific evidence and quantified the combined estimates to show the association of MRC with clinical outcomes: hospitalization, hospital readmission, and medication adherence.