Are Clinical Outcomes Associated With Medication Regimen Complexity? A Systematic Review and Meta-analysis

Alves-Conceição, Vanessa; Rocha, Kérilin Stancine Santos; Silva, Fernanda Vilanova Nascimento; Silva, Rafaella de Oliveira Santos; Cerqueira-Santos, Sabrina; Nunes, Marco Antônio Prado; Martins-Filho, Paulo Ricardo; Silva, Daniel Tenório da; Lyra, Divaldo Pereira de

doi:10.1177/1060028019886846

Cited by 35 publications

(19 citation statements)

References 55 publications

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“…In a recent meta-analysis, the association between the degree of medication complexity and the clinical outcomes of hospitalisation, hospital readmission and medication non-adherence across different studies has been reported. 27 Furthermore, a recent systematic review on the medication adherence interventions highlighted the need to focus on the interventions that deemed to be effective to improve adherence such as medication regimen simplification, education and reminders. 28 However, to the author's knowledge, this is the first study that has assessed the impact of medicine regimen simplification strategies on medicine adherence and clinical outcomes in patients with long-term medical conditions.…”

Section: Discussionmentioning

confidence: 99%

<p>Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions</p>

Elnaem¹,

Irwan²,

Abubakar³

et al. 2020

PPA

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Background This study aims to identify interventions used to reduce medication regimen complexity and to assess their impact on medication adherence and clinical outcomes. Methods A literature search was conducted using pre-defined search terms in three scientific databases, including ScienceDirect, ProQuest and MEDLINE. Original research articles published in English between 2009 and 2020 that assessed the impact of medication regimen simplification on medication adherence in patients with long-term medical conditions were eligible for inclusion. Review articles, meta-analysis studies and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form. Results Of the 684 studies identified through initial searches, 17 studies were included in the review. Nine studies involved simplification of medication regimen related to HIV, while three studies focused on patients with diabetes with or without coronary artery disease. The remaining five studies included medications used among elderly patients or medications related to hypertension, psychiatric disorders, glaucoma and kidney diseases. Three medication regimen simplification strategies were identified; fixed-dose combination (n = 7), once-daily dosing (n = 4) and the combination of both fixed-dose and once-daily dosing (n = 6). Overall, most of the regimen simplification strategies (14 out of 17) were found to be useful in improving medication adherence. There was no assessment of clinical outcomes in four out of 17 studies. Furthermore, more than half of the studies that assessed clinical outcomes did not show any additional impact on clinical outcomes. Conclusion The findings suggest that there was an equal utilization of the three main approaches of regimen simplifications; fixed-dose combination, once-daily dosing and a combination of both. Overall, most of the regimen simplification strategies were found to be effective in improving medication adherence. However, the associated improvement in medication adherence did not extend to improvement in the clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

<p>Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions</p>

Elnaem¹,

Irwan²,

Abubakar³

et al. 2020

PPA

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“…Defining MRCI cutoffs to categorize medication complexity may be dependent upon the studied population, based on previous MRCI studies. 4 , 8 , 10 - 12 Studies have been conducted in diverse populations, and there are no consistent cutoffs that define low and high complexity in the general population. For instance, 1 study 8 that evaluated the MRCI in defined populations with chronic disease (geriatric depression, human immunodeficiency virus, diabetes mellitus, and hypertension) found that the MRCI values for meeting complexity thresholds for high and low MRCI scores differed between disease-specific cohorts.…”

Section: Introductionmentioning

confidence: 99%

“… 8 Additionally, impact of MRCI cutoffs on readmissions were either not reported or findings were not conclusive, limiting associations related to MRCI scores and readmission risk. 4 , 8 , 10 - 12 To our knowledge, only 1 study 4 has looked specifically at utilizing MRCI in psychiatric patients and found average MRCI scores of 17.62 and 19.36. The study focused on adults age 65 years or older with depression and, therefore, did not represent a nonelderly psychiatric population.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the medication regimen complexity index in high-utilizer, adult psychiatric patients

Harris

Jean²

2020

Mental Health Clinician

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Abstract Introduction Few studies have examined the role of medication-related factors in psychiatric readmissions. Our objective was to characterize the medication regimen complexity index (MRCI) and assess its association with psychiatric hospital readmission frequency and time to readmission in a high-utilizer psychiatric cohort. Methods Adult patients admitted between July 2012 and March 2014 were identified if discharged from an inpatient psychiatry service with greater than or equal to 5 psychiatric readmissions or at least one 30-day readmission. Complexity of the medication regimen was determined using a validated MRCI electronic capture tool. Results One hundred sixty-eight patients were included. Average MRCI for all readmissions was 7.09 for psychotropic medications, 5.90 for other prescription medications, 2.98 for over the counter, and 16.00 for total medications. Ages greater than 65 years old and female sex were associated with higher total MRCI scores. Average MRCI for psychotropic medications and average psychotropic medication count, along with depression diagnosis, were found to be significantly associated with average time between each readmission but not with readmission frequency. An average total MRCI score greater than 19.7, when broken down by percentiles, was associated with a shorter time to readmission. Discussion Psychotropic regimen complexity, psychotropic medication count, total MRCI greater than 19.7, and a diagnosis of depression may contribute to a shorter time to readmission in adult psychiatric patients with a history of frequent readmissions. Future studies are needed to confirm findings and evaluate clinical significance and impact.

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“…The dimensions with the worst assessment were Anxiety/Depression, Pain/discomfort and Self- The MRCI index is a validated 65-item tool that evaluates treatment regimen complexity based on the number of medications, dosage form, dosage frequency, and additional or special instructions. This index score ranges from 1.5 (for someone taking a single tablet or capsule taken once a day) to an undefined maximum since the score increases with the number of medications; greater scores indicate higher complexity [18]. Additionally, according to Morillo-Verdugo et al [19] a cut-off value of 11.25 for MRCI index score was employed for considering complex patient.…”

Section: Resultsmentioning

confidence: 99%

High level of medication regimen complexity index correlate with worse quality of life in people living with HIV

et al. 2021

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Objectives. People living with HIV (PLWHIV) have now a near-normal life expectancy and thus, a higher risk of polypharmacy. The main objective was to assess the correlation between medication regimen complexity index (MRCI) and quality of life (EQ-5D) and health utilities among PLWHIV patients on ART. Patients and methods. Observational prospective single-center study including adult PLWHIV on ART from January to March-2020 attended at hospital pharmacy outpatient service according to a Capacity-Motivation-Opportunity (CMO) pharmaceutical care model. Results. A total of 428 patients were included, mean age of 50 ± 10.9 years, 82.2% males. Negative correlation (r2=−0.147; p= 0.0002) between MRCI and EQ-5D was found. Relationship between the comorbidity pattern and quality of life, was also observed. Regarding MRCI, Anxiety/Depression, Pain/discomfort and Self-Care were the dimensions with the worst assessment. Conclusions. A new multidimensional revised care plan for PLWHIV focussed on optimising overall patient care, not limited to viral load goal achievement alone but also in their pharmacotherapeutic complexity and quality of life is needed.

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Are Clinical Outcomes Associated With Medication Regimen Complexity? A Systematic Review and Meta-analysis

Cited by 35 publications

References 55 publications

<p>Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions</p>

<p>Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions</p>

Characterization of the medication regimen complexity index in high-utilizer, adult psychiatric patients

High level of medication regimen complexity index correlate with worse quality of life in people living with HIV

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