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Pharmacists and Medication Regimen Complexity
Medication regimen complexity (MRC) may influence health outcomes, such as hospitalisation, hospital readmission and medication adherence. Pharmacists have been referred to as health professionals with the opportunity to act on MRC reduction.
Nowadays the world faces global ageing, often associated with a high prevalence of multimorbidities. As a natural consequence, older age frequently stands out for polypharmacy and complex medication regimens . When considering medication regimen complexity (MRC), there is so far no clear definition for it . However, it has already been shown that the number of drugs is only one of the relevant factors to consider, and that, in addition, dosage form, dosage frequency and administration instructions also have to be considered . Furthermore, there is also no agreement about the reference instrument for MRC determination . Several tools have been used, with the 65-item medication regimen complexity index (MRCI), developed by George et al. , being the most common, reliable and validated tool for this purpose, which has already been translated and validated to a few languages  and even standardised for older adults in primary care . It is an open-ended index, with higher total MRCI scores representing more complex medication regimens.
Interest in this subject has grown because numerous studies have associated high MRC with non-adherence , higher hospitalisation rates , hospital discharge destination different than home  and low overall quality of life . Indeed, medication management may frequently be demanding for the older population, their caregivers and healthcare professionals. In fact, older adults often present reduced manual dexterity in addition to cognitive and sensory impairment that can lead to a higher risk of medication errors and drug-related problems (DRPs) . In order to reduce these negative aspects, it seems imperative to attempt medication regimen simplifications in many circumstances. Some research has already investigated its feasibility, with evidence suggesting that complexity can be reduced, and referring to pharmacists as healthcare professionals with a great potential to perform it in routine pharmaceutical dispensing or as part of medication reviews . Indeed, pharmacists have a privileged access to the population’s medication, both in community pharmacies and hospital settings, and awareness of this topic is needed, especially in the older population, for whom managing their daily medication may often represent a considerable challenge.
Up to the present date, to the best of our knowledge, there are no systematic reviews available about the role that pharmacists play in the older population’s MRC and the effort made to simplify it. To address this gap, this study aimed to examine and describe pharmacists’ role in studies on older adults’ MRC.
2. Pharmacists’ Role in Older Adults’ Medication Regimen Complexity
2.1. Medication Regimen Complexity Assessment
2.2. Measured Outcomes
2.3. Study Setting
2.4. Pharmacists’ Role
Old age is often synonymous with multiple comorbidities and consequently polypharmacy and complex medication regimens. As the latter has been associated with several negative outcomes, particularly in the older population, an effort should be made to reduce MRC whenever possible. Pharmacists may play a relevant role at this point after previous training, which has, however, been underexplored. There is almost no research on pharmacists’ intervention on older people’s MRC; that which does exist is of moderate quality. This aspect leaves an open door for future high-quality evidence investigations on pharmacists’ interventions and their relation to better outcomes. Therefore, pharmacists should be provided with the necessary skills, either during graduation or in post-graduate education and training programs, and encouraged to assess the possibility of simplifying the medication regimen in their daily routine or even on a service-based remuneration model.
The entry is from 10.3390/ijerph18168824
- World Health Organization. World Report on Ageing and Health; World Health Organization Press: Geneva, Switzerland, 2015.
- Advinha, A.M.; De Oliveira-Martins, S.; Mateus, V.; Pajote, S.G.; Lopes, M.J. Medication regimen complexity in institutionalized elderly people in an aging society. Int. J. Clin. Pharm. 2014, 36, 750–756.
- Silva, C.; Ramalho, C.; Luz, I.; Monteiro, J.; Fresco, P. Drug-related problems in institutionalized, polymedicated elderly patients: Opportunities for pharmacist intervention. Int. J. Clin. Pharm. 2015, 37, 327–334.
- Pantuzza, L.L.N.; Ceccato, M.D.G.B.; Silveira, M.R.; Junqueira, L.M.R.; Reis, A. Association between medication regimen complexity and pharmacotherapy adherence: A systematic review. Eur. J. Clin. Pharmacol. 2017, 73, 1475–1489.
- Paquin, A.M.; Zimmerman, K.M.; Kostas, T.R.; Pelletier, L.; Hwang, A.; Simone, M.; Skarf, L.M.; Rudolph, J.L. Complexity perplexity: A systematic review to describe the measurement of medication regimen complexity. Expert Opin. Drug Saf. 2013, 12, 829–840.
- Advinha, A.M.; Lopes, M.; De Oliveira-Martins, S. Assessment of the elderly’s functional ability to manage their medication: A systematic literature review. Int. J. Clin. Pharm. 2016, 39, 1–15.
- Wimmer, B.C.; Johnell, K.; Fastbom, J.; Wiese, M.; Bell, J.S. Factors associated with medication regimen complexity in older people: A cross-sectional population-based study. Eur. J. Clin. Pharmacol. 2015, 71, 1099–1108.
- Herson, M.; Bell, J.; Tan, E.; Emery, T.; Robson, L.; Wimmer, B. Factors associated with medication regimen complexity in residents of long-term care facilities. Eur. Geriatr. Med. 2015, 6, 561–564.
- Ferreira, J.M.; Galato, D.; Melo, A.C. Medication regimen complexity in adults and the elderly in a primary healthcare setting: Determination of high and low complexities. Pharm. Pr. 2015, 13, 659.
- Elliott, R.A.; O’Callaghan, C.J. Impact of Hospitalisation on the Complexity of Older Patients’ Medication Regimens and Potential for Regimen Simplification. J. Pharm. Pr. Res. 2011, 41, 21–25.
- Witticke, D.; Seidling, H.M.; Lohmann, K.; Send, A.F.J.; Haefeli, W.E. Opportunities to Reduce Medication Regimen Complexity: A retrospective analysis of patients discharged from a university hospital in Germany. Drug Saf. 2012, 36, 31–41.
- Elliott, R.A.; O’Callaghan, C.; Paul, E.; George, J. Impact of an intervention to reduce medication regimen complexity for older hospital inpatients. Int. J. Clin. Pharm. 2013, 35, 217–224.
- Stange, D.; Kriston, L.; Von-Wolff, A.; Baehr, M.; Dartsch, D.C. Reducing Cardiovascular Medication Complexity in a German University Hospital: Effects of a Structured Pharmaceutical Management Intervention on Adherence. J. Manag. Care Pharm. 2013, 19, 396–407.
- Rettig, S.M.; Wood, Y.; Hirsch, J.D. Medication regimen complexity in patients with uncontrolled hypertension and/or diabetes. J. Am. Pharm. Assoc. 2013, 53, 427–431.
- George, J.; Phun, Y.-T.; Bailey, M.J.; Kong, D.C.; Stewart, K. Development and Validation of the Medication Regimen Complexity Index. Ann. Pharmacother. 2004, 38, 1369–1376.
- Melchiors, A.C.; Correr, C.J.; Fernandez-Llimos, F. Tradução e validação para o português do Medication Regimen Complexity Index. Arq. Bras. Cardiol. 2007, 89, 210–218.
- Stange, D.; Kriston, L.; Langebrake, C.; Cameron, L.K.; Wollacott, J.D.; Baehr, M.; Dartsch, D.C. Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCI-D). J. Eval. Clin. Pr. 2011, 18, 515–522.
- De La Fuente, J.S.; Díaz, A.S.; Cañamares, I.; Ramila, E.; Izquierdo-Garcia, E.; Esteban, C.; Escobar-Rodríguez, I. Cross-cultural Adaptation and Validation of the Medication Regimen Complexity Index Adapted to Spanish. Ann. Pharmacother. 2016, 50, 918–925.
- Pantuzza, L.L.N.; Ceccato, M.D.G.B.; Silveira, M.R.; Pinto, I.V.; Reis, A. Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care. Geriatr. Gerontol. Int. 2018, 18, 853–859.
- Wimmer, B.C.; Cross, A.J.; Jokanovic, N.; Wiese, M.; George, J.; Johnell, K.; Diug, B.; Bell, J.S. Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J. Am. Geriatr. Soc. 2016, 65, 747–753.
- De Vries, S.T.; Keers, J.C.; Visser, R.; De Zeeuw, D.; Haaijer-Ruskamp, F.M.; Voorham, J.; Denig, P. Medication beliefs, treatment complexity, and non-adherence to different drug classes in patients with type 2 diabetes. J. Psychosom. Res. 2014, 76, 134–138.
- Wimmer, B.C.; Dent, E.; Visvanathan, R.; Wiese, M.; Johnell, K.; Chapman, I.; Bell, J.S. Polypharmacy and Medication Regimen Complexity as Factors Associated with Hospital Discharge Destination Among Older People: A Prospective Cohort Study. Drugs Aging 2014, 31, 623–630.
- Fröhlich, S.E.; Zaccolo, A.V.; Da Silva, S.L.C.; Mengue, S.S. Association between drug prescribing and quality of life in primary care. Pharm. World Sci. 2010, 32, 744–751.
- Alves-Conceição, V.; Rocha, K.S.S.; Silva, F.V.N.; Silva, R.O.S.; Da Silva, D.T.; De Lyra, D.P., Jr. Medication Regimen Complexity Measured by MRCI: A Systematic Review to Identify Health Outcomes. Ann. Pharmacother. 2018, 52, 1117–1134.
- Acurcio, F.A.; Silva, A.L.; Ribeiro, A.Q.; Rocha, N.P.; Silveira, M.R.; Klein, C.H.; Rozenfeld, S. Complexidade do regime terapêutico prescrito para idosos. Rev. Assoc. Med. Bras. 2009, 55, 468–474.
- Conn, V.S.; Taylor, S.G.; Kelley, S. Medication Regimen Complexity and Adherence Among Older Adults. Image J. Nurs. Sch. 1991, 23, 231–236.
- Wimmer, B.C.; Bell, J.S.; Fastbom, J.; Wiese, M.; Johnell, K. Medication Regimen Complexity and Polypharmacy as Factors Associated With All-Cause Mortality in Older People: A population-based cohort study. Ann. Pharmacother. 2015, 50, 89–95.
- Hirsch, J.D.; Metz, K.R.; Hosokawa, P.W.; Libby, A. Validation of a Patient-Level Medication Regimen Complexity Index as a Possible Tool to Identify Patients for Medication Therapy Management Intervention. Pharmacother. J. Hum. Pharmacol. Drug Ther. 2014, 34, 826–835.
- Wimmer, B.C.; Dent, E.; Bell, J.S.; Wiese, M.D.; Chapman, I.; Johnell, K.; Visvanathan, R. Medication Regimen Complexity and Unplanned Hospital Readmissions in Older People. Ann. Pharmacother. 2014, 48, 1120–1128.
- Libby, A.M.; Fish, D.N.; Hosokawa, P.W.; Linnebur, S.A.; Metz, K.R.; Nair, K.V.; Saseen, J.; Griend, J.P.V.; Vu, S.P.; Hirsch, J.D. Patient-Level Medication Regimen Complexity Across Populations With Chronic Disease. Clin. Ther. 2013, 35, 385–398.
- Linnebur, S.A.; Griend, J.P.V.; Metz, K.R.; Hosokawa, P.W.; Hirsch, J.D.; Libby, A.M. Patient-level Medication Regimen Complexity in Older Adults with Depression. Clin. Ther. 2014, 36, 1538–1546.e1.
- Kozma, C.M.; Reeder, C.E.; Schultz, R.M. Economic, clinical, and humanistic outcomes: A planning model for pharmacoeconomic research. Clin. Ther. 1993, 15, 1121–1132.
- Charrois, T.L.; Durec, T.; Tsuyuki, R.T. Systematic Reviews of Pharmacy Practice Research: Methodologic Issues in Searching, Evaluating, Interpreting, and Disseminating Results. Ann. Pharmacother. 2009, 43, 118–122.
- American Geriatrics Society. American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc. 2019, 67, 674–694.
- O’Mahony, D.; O’Sullivan, D.; Byrne, S.; O’Connor, M.N.; Ryan, C.; Gallagher, P. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing 2014, 44, 213–218.
- Lindquist, L.A.; Lindquist, L.M.; Zickuhr, L.; Friesema, E.; Wolf, M.S. Unnecessary complexity of home medication regimens among seniors. Patient Educ. Couns. 2014, 96, 93–97.
- Pinto, I.V.L.; Reis, A.; Almeida-Brasil, C.C.; Da Silveira, M.R.; Lima, M.G.; Ceccato, M.D.G.B. Avaliação da compreensão da farmacoterapia entre idosos atendidos na Atenção Primária à Saúde de Belo Horizonte, MG, Brasil. Cien. Saude Colet. 2016, 21, 3469–3481.
- Elliott, R.A. Reducing medication regimen complexity for older patients prior to discharge from hospital: Feasibility and barriers. J. Clin. Pharm. Ther. 2012, 37, 637–642.
- Moczygemba, L.R.; Barner, J.C.; Gabrillo, E.R. Outcomes of a Medicare Part D telephone medication therapy management program. J. Am. Pharm. Assoc. 2012, 52, e144–e152.
- Pouranayatihosseinabad, M.; Zaidi, S.T.R.; Peterson, G.; Nishtala, P.S.; Hannan, P.; Castelino, R. The impact of residential medication management reviews (RMMRs) on medication regimen complexity. Postgrad. Med. 2018, 130, 575–579.
- Lakey, S.L.; Gray, S.L.; Borson, S. Assessment of Older Adults’ Knowledge of and Preferences for Medication Management Tools and Support Systems. Ann. Pharmacother. 2009, 43, 1011–1019.
- Anderson, S. The state of the world’s pharmacy: A portrait of the pharmacy profession. J. Interprofessional Care 2002, 16, 391–404.