Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities
Main Article Content
Keywords
Drug Administration Schedule, Pharmaceutical Preparations, Polypharmacy, Pharmacoepidemiology, Brazil
Abstract
Background: The complexity of a medication regimen is related to the multiple characteristics of the prescribed regimen and can negatively influence the health outcomes of patients.
Objective: To propose cut-off points in the complexity of pharmacotherapy to distinguish between patients with low and high complexities seen in a primary health care (PHC) setting to enable prioritization of patient management.
Methods: This is a cross-sectional study, which included 517 adult and elderly patients, analyzing different cut-off points to define the strata of low and high pharmacotherapy complexities based on percentiles of the population evaluated. Data collection began with the solicitation of prescriptions, followed by a questionnaire that was administered by an interviewer. The complexity of a medication regimen was estimated from the Medication Regimen Complexity Index (MRCI). High complexity pharmacotherapy scores were analyzed from patient profiles, the use of health services, and pharmacotherapy. The criteria for subject inclusion in the sample population were as follows: inhabitant of the area covered by the municipality, 18 years or older, and being prescribed at least one drug during the collection period. Exclusion criteria at the time of collection were the use of any medication whose prescription was not available. All medications were accessed through the Primary Healthcare Service (PHS).
Results: The median total pharmacotherapy complexity score was 8.5. High MRCI scores were correlated with age, medications taken with in the Brazilian PHS, having at least one potential drug-related problem, receiving up to eight years of schooling, number of medications and polypharmacy (five or more medicines), number of medical conditions, number of medical appointments, and number of cardiovascular diseases and endocrine metabolic diseases. We suggest different complexity tracks according to age (e.g., adult or elderly) that consider the pharmacotherapy and population coverage characteristics as high complexity limits. For the elderly patients, the tracks were as follows: MRCI≥25.4, MRCI≥20.9, MRCI≥17.5, MRCI≥15.7, MRCI≥14.0, and MRCI≥13.0. For adult patients, the limits of high complexity were MRCI≥25.1; MRCI ≥ 23.8; MRCI≥21.0; MRCI≥17.0; MRCI≥16.5; and MRCI≥15.5.
Conclusion: The medication regimen complexity is associated with the patient's illness profile and problems with the use of drugs; therefore, the proposed scores can be useful in prioritizing patients for clinical care by pharmacists and other health professionals.
References
2. Muir AJ, Sanders LL, Wilkinson WE, Schmader K. Reducing medication regimen complexity: a controlled trial. J Gen Intern Med. 2001;16(2):77-82.
3. Libby AM, Fish DN, Hosokawa PW, Linnebur SA, Metz KR, Nair KV, Saseen JJ, Vande Griend JP, Vu SP, Hirsch JD. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther. 2013;35(4):385-398. doi: 10.1016/j.clinthera.2013.02.019
4. Metz KR, Fish DN, Hosokawa PW, Hirsch JD, Libby AM. Patient-Level Medication Regimen Complexity in Patients with HIV. Ann Pharmacother. 2014; 48(9):1129-1137.
5. Wimmer BC, Dent E, Bell JS, Wiese MD, Chapman I, Johnell K, Visvanathan R. Medication Regimen Complexity and Unplanned Hospital Readmissions in Older People. Ann Pharmacother. 2014; 48(9):1120-1128.
6. George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369-1376
7. Mansur N, Weiss A, Beloosesky Y. Looking Beyond Polypharmacy: Quantification of Medication Regimen Complexity in the Elderly. Am J Geriatr Pharmacother. 2012;10(4):223-229. doi: 10.1016/j.amjopharm.2012.06.002
8. Márquez Contreras E, de la Figuera von Wichmann M, Roig Ponsa L, Naval Chamosa J. [Compliance with hypertension therapy in Spain, according to the views of family doctors. Complex project]. Aten Primaria. 2007;39(8):417-423.
9. Marshall WJ, Lapsley M, Day A, Ayling R. Clinical Biochemistry:Metabolic and Clinical Aspects. London: Churchill Livingstone; 2014. ISBN: 978-0-7020-5140-1
10. Flores LM, Mengue SS. Drug use by the elderly in Southern Brazil. Rev Saúde Pública 2005; 39(6): 924-929.
11. Haider SI, Johnell K, Thorslund M, Fastbom J. Analysis of the association between polypharmacy and socioeconomic position among elderly aged > or =77 years in Sweden. Clin Ther. 2008;30(2):419-427. doi: 10.1016/j.clinthera.2008.02.010
12. Neves SJ, Marques AP, Leal MC, Diniz Ada S, Medeiros TS, Arruda IK. Epidemiology of medication use among the elderly in an urban area of Northeastern Brazil. Rev Saude Publica. 2013;47(4):759-767. doi: 10.1590/S0034-8910.2013047003768
13. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. New Yourk: Mc Graw Hill; 1998. ISBN: 0-07-012046-3
14. Micromedex® Healthcare Series [Internet database]. Greenwood Village, Colo: Thomson Healthcare.
15. Advinha AM, de Oliveira-Martins S, Mateus V, Pajote SG, Lopes MJ. Medication regimen complexity in institutionalized elderly people in an aging society. Int J Clin Pharm. 2014;36(4):750-756. doi: 10.1007/s11096-014-9963-4
16. Flores VB, Benvegnú LA. [Use of medicines by the elderly in Santa Rosa, Rio Grande do Sul State, Brazil].Cad Saude Publica. 2008;24(6):1439-1446.
17. Cruciol-Souza JM, Thomson JC, Catisti DG. Evaluation of prescription data of a Brazilian teaching hospital.Rev Bras Educ Med. 2008; 32 (2):188-196. doi: 10.1590/S0100-55022008000200006
18. McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, Feldman PH. Automating the medication regimen complexity index. J Am Med Inform Assoc. 2013;20(3):499-505. doi: 10.1136/amiajnl-2012-001272
19. Aldrigue RFT, Correr CJ, Melchiors AC, Pantarolo R. Analysis of filling out of prescriptions dispensing in a community pharmacy of Fazenda Rio Grande - Paraná (Brazil). Acta Farm Bonaerense 2006; 25 (3):454-459.
20. Andrade MF, Andrade RCG, Santos, V. [Psychotropic prescription: the evaluation of related directions and notifications]. Rev Bras Cienc Farm. 2004;40(4):471-479. doi: 10.1590/S1516-93322004000400004
21. Hepler CD, Segal R. Preventing medication errors and improving drug therapy outcomes: A management systems approach. Boca Raton (FL): CRC Press; 2003.
22. Ev LS, Guimarães AG, Castro VS. Analysis of Medical Prescriptions Dispensed at Health Centers in Ouro Preto, Minas Gerais, Brazil. Lat Am J Pharm. 2008;27(4):543-547.
23. Langford NJ, Landray M, Martin U, Kendall MJ, Ferner RE. Testing the practical aspects of therapeutics by objective structured clinical examination. J Clin Pharm Ther. 2004;29(3):263-266.
24. Nikendei C, Kraus B, Schrauth M, Briem S, Jünger J. Ward rounds: how prepared are future doctors? Med Teach. 2008;30(1):88-91. doi: 10.1080/01421590701753468
25. Silva ERB, Bandeira VAC, Oliveira KR. [Evaluation of prescriptions dispensed in a community pharmacy in the city of Sao Luiz Gonzaga – RS]. Rev Ciênc Farm Básica Apl. 2012; 33(2):275-281.
26. Banning M. Older people and adherence with medication: A review of the literature. Int J Nurs Stud. 2008;45(10):1550-1561. doi: 10.1016/j.ijnurstu.2008.02.009
27. Garber MC, Nau DP, Erickson SR, Aikens JE, Lawrence JB. The concordance of self-report with other measures of medication adherence: a summary of the literature. Med Care. 2004;42(7):649-652.
28. Van de Steeg N, Sielk M, Pentzek M, Bakx C, Altiner A. Drug-adherence questionnaires not valid for patients taking blood-pressure-lowering drugs in a primary health care setting. J Eval Clin Pract. 2009;15(3):468-472. doi: 10.1111/j.1365-2753.2008.01038.x
29. Correr CJ, Melchiors AC, Rossignoli P, Fernandez-Llimos. [Applicability of situation sheet on calculating medication complexity in diabetic patients]. Seguim Farmacot. 2005;3(2):103-111.
30. Acúrcio FA, Silva ALS, Ribeiro AQ, Rocha NP, Silveira MR, Klein CH, Rozenfeld S. Complexidade do regime terapêutico prescrito para Idosos. Rev Assoc Med Bras. 2009;55(4):468-474. doi: 10.1590/S0104-42302009000400025
31. Paquin AM, Zimmerman KM, Kostas TR, Pelletier L, Hwang A, Simone M, Skarf LM, Rudolph JL. Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity. Expert Opin Drug Saf. 2013;12(6):829-840. doi: 10.1517/14740338.2013.823944
32. Stange D, Kriston L, Von-Wolff A, Baehr M, DartschDC. Reducing cardiovascular medication complexity in a German university hospital: effects of a structured pharmaceutical management intervention on adherence. J Manag Care Pharm. 2013;19(5):396-407.
33. Martínez BB, Ferreira NC. [Assessment of medication regimen complexity among diabetics]. Rev Med Minas Gerais 2012;22(2):133-138.
34. Olson CH, Dierich M, Adam T, Westra BL. Optimization of decision support tool using medication regimens to assess rehospitalization risks. Appl Clin Inform. 2014;5(3):773-788. doi: 10.4338/ACI-2014-04-RA-0040
35. Dierich MT, Mueller C, Westra BL. Medication regimens in older home care patients. J Gerontol Nurs. 2011 ec;37(12):45-55. doi: 10.3928/00989134-20111103-02
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.