Validation of the Turkish version of medication regimen complexity index among elderly patients

Evaluation of potentially inappropriate medications use and medication complexity in elderly patients applying to community pharmacy in Turkey

BACKGROUND

Older adults often use multiple medicines to manage comorbidities well or to prevent associated complications. This study aims to determine polypharmacy, the use of potentially inappropriate medications (PIMs) using the 2019 Beers Criteria and to determine the Medication Regimen Complexity Index (MRCI) score. It also aims to identify factors associated with the presence of PIMs and the MRCI score.

METHODS

This cross-sectional study was carried out between 6 and 2023 and 5 May 2023 in a community pharmacy in Turkey. Elderly patients over 65 years of age, who used at least one drug, and who came to the pharmacy for any reason were included in the study. PIMs were determined according to the 2019 Beers Criteria. The Turkish validated version of the MRCI was used to determine the medication complexity score.

RESULTS

200 patients were included in this study. 59.5% of the patients were female and the median age was 70 (IQR, 66-74.75). Polypharmacy was detected in 33% of patients. The use of PIMs was determined in 63.5% of the patients. The median of the MRCI score was 11 (IQR, 7-15). The number of chronic diseases and drugs, presence of polypharmacy, MRCI score and mental disorders were found to be significantly higher in those with PIMs than in those without (p < 0.05). Having less than eight years of education, presence of polypharmacy, the presence of comorbidity (diabetes mellitus, cardiovascular disease, thyroid, chronic obstructive pulmonary disease (COPD), asthma and mental disorders) were associated with significantly higher MRCI scores (p < 0.05).

CONCLUSIONS

According to the results of our study, it was found that the elderly patients who came to the pharmacy had low MRCI scores, but had high PIMs use. Community pharmacists have an important role in identifying inappropriate drug use, so they should be trained to develop skills in identifying and reducing PIMs in older patients.

What Factors Influence Treatment Effectiveness in Rheumatoid Arthritis: An Evidence-Based Approach to Multidimensional Measurement of Treatment Effectiveness

Purpose: The aim of the study was to examine the effects of socio-demographic characteristics, disease-related characteristics and health care use related-characteristics on the treatment effectiveness of rheumatoid arthritis patients, both separately and together. Methods: The sample of the study consisted of 440 rheumatoid arthritis patients for 99% confidence level, and this sample was reached based on the convenience sampling method. Patients who received at least one anti-TNF therapy were included in the study. Treatment effectiveness levels of rheumatoid arthritis patients were measured with a questionnaire. In the analysis of the study, four different regression models were established. In the first model, socio-demographic characteristics; in the second model, disease characteristics; in the third model, health care use characteristics: in the fourth model, the effect of all these variables on treatment effectiveness was examined. Results: In the study, smoking status, age (socio-demographic characteristics), drug regimen complexity, comorbidity status, education about the disease, disease duration (disease characteristics), and a number of admissions (health care use characteristics), were found to have a significant effect on treatment effectiveness. Conclusion: In the study, the factors affecting the treatment effectiveness were determined. Therefore, it is important to consider these factors revealed in this study in order to increase the treatment effectiveness in patients with rheumatoid arthritis.

Polypharmacy, potentially inappropriate prescribing and medication complexity in Turkish older patients in the community pharmacy setting

OBJECTIVE

This study aimed to evaluate polypharmacy, potentially inappropriate prescribing (PIP) and medication complexity in Turkish older patients in the community pharmacy setting and to determine the factors associated with PIP.

METHODS

This descriptive cross-sectional study was conducted in the community pharmacy setting in Istanbul. Older patients (≥65 years old) who chronically used at least one medication and visited the community pharmacy for any reason in the past 4 months were invited in this study. PIP was determined by using the Ghent Older People's Prescriptions Community Pharmacy Screening (GheOP³S)-tool. The Turkish version of the Medication Regimen Complexity Index (MRCI) was used to determine medication complexity.

RESULTS

Polypharmacy (defined as the concurrent use of five or more medications) was found in 69.0% of 158 patients. A total of 398 PIPs were detected and 83.5% (n = 132) of older patients had at least one PIP. The median (IQR) MRCI score was 12.5 (7.0-19.6). The factors associated with having ≥2 PIP were advanced age (≥75 years old) (OR = 2.87, 95% CI 1.41-5.81; p < 0.05), higher number of chronic diseases (when ≥3, OR = 8.51, 95% CI 3.66-19.76; p < 0.05), receiving polypharmacy (OR = 8.92, 95% CI 4.09-19.46; p < 0.05), and higher MRCI scores (when MRCI ≥12.5, OR = 4.40, 95% CI 2.22-8.71; p < 0.05).

CONCLUSION

More than half of the Turkish older patients had polypharmacy and the rate of PIP was high. A higher number of PIP was associated with advanced age, higher number of chronic diseases, polypharmacy, and more complex medication regimens.

Development of medication regimen complexity index: Japanese version and application in elderly patients

Background Medication regimen complexity includes various aspects of a regimen, including the dosage form, number of medications and need for additional information for use. Complicated medication regimens cause non-adherence to prescribed medications, making it essential to evaluate medication regimen complexity in older adults to improve adherence to prescribed medications and clinical outcomes. The medication regimen complexity index is currently the most widely used scale for quantifying regimen complexity; however, it has yet to be adopted in Japan. Objective This study aimed to translate the medication regimen complexity index to Japanese and assess its reliability and validity for application in elderly patients in Japan. Setting This study was conducted in a clinic that provides home medical care to patients in the southern part of Ibaraki prefecture, Japan. Method The validation process consisted of translation of the original English version of the medication regimen complexity index to Japanese followed by back-translation to English, comparison of the back-translated and original versions, pilot testing, and assessment of the Japanese version by two raters using the medication regimens of 72 patients with chronic diseases. Main outcome measure The psychometric properties of the index were evaluated according to inter-rater and test-retest reliability, and convergent and discriminant validity. Results The mean age of the 72 patients was 84.3 years. The scale showed high inter-rater reliability (intraclass correlation coefficient 0.946) and test-retest reliability (intraclass correlation coefficient 0.991) for total scores. The number of medications was positively correlated with total medication regimen complexity index score (r_s = 0.930, P < 0.001). There were no statistically significant differences between age, sex and Charlson Comorbidity Index and medication regimen complexity index score (P > 0.05). Conclusions The Japanese version of the medication regimen complexity index is a reliable and valid tool for assessing the complexity of medication regimen in Japanese elderly patients.

Development and validation of the Korean version of the medication regimen complexity index

The medication regimen complexity index (MRCI), originally developed in English, is a reliable and valid tool to assess the complexity of pharmacotherapy. This study aimed to validate the Korean version of MRCI (MRCI-K). A cross-cultural methodological study comprising 335 discharged patients of a tertiary hospital in Korea was conducted. The translation process included translation into Korean by two clinical pharmacists, back translation by two native speakers, and a pretest of the tool, culminating in the Korean version of MRCI-K. Reliability analysis was assessed using inter-rater and test–retest reliability with 25 randomly selected patients. Convergent and discriminant validity analyses were conducted by correlating MRCI scores with medication number, age, sex, adverse drug reaction (ADR) reports, and length of stay. The criterion validity was confirmed through evaluation by a nine-member expert panel that subjectively ranked these regimens. The reliability analysis demonstrated excellent internal consistency (Cronbach’s α = 0.977), and the intraclass correlation coefficient exceeded 0.90 for all cases. The correlation coefficient for the number of medications was 0.955 (P < 0.001). Weak significant correlations were observed with age and length of stay. The MRCI-K group with ADR reports scored higher (mean, 31.8) than the group without ADR reports (mean, 27.3). The expert panel’s ranking had a stronger correlation with the MRCI ranking than the medication number ranking. MRCI-K has similar reliability and validity as MRCI and is useful for analyzing therapeutic regimens with potential applications in both practice and research in Korea.

Medication Regimen Complexity Measured by MRCI: A Systematic Review to Identify Health Outcomes

Objective: To perform a systematic review to identify health outcomes related to medication regimen complexity as measured by the Medication Regimen Complexity Index (MRCI) instrument. Data Sources: Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science were searched from January 1, 2004, until April 02, 2018, using the following search terms: outcome assessment, drug therapy, and Medication Regimen Complexity Index and their synonyms in different combinations. Study Selection and Data Extraction: Studies that used the MRCI instrument to measure medication regimen complexity and related it to clinical, humanistic, and/or economic outcomes were evaluated. Two reviewers independently carried out the analysis of the titles, abstracts, and complete texts according to the eligibility criteria, performed data extraction, and evaluated study quality. Data Synthesis: A total of 23 studies met the inclusion criteria; 18 health outcomes related to medication regimen complexity were found. The health outcomes most influenced by medication regimen complexity were hospital readmission, medication adherence, hospitalization, adverse drug events, and emergency sector visit. Only one study related medication regimen complexity with humanistic outcomes, and no study related medication regimen complexity to economic outcomes. Most of the studies were of good methodological quality. Relevance to Patient Care and Clinical Practice: Health care professionals should pay attention to medication regimen complexity of the patients because this may influence health outcomes. Conclusion: 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.

Cross-cultural Adaptation and Validation of the Medication Regimen Complexity Index Adapted to Spanish

Background: The most widely used validated instrument to assess the complexity of medication regimens is the Medication Regimen Complexity Index (MRCI). Objective: This study aimed to translate, adapt, and validate a reliable version of the MRCI adapted to Spanish (MRCI-E). Methods: The cross-cultural adaptation process consisted of an independent translation by 3 clinical pharmacists and a backtranslation by 2 native English speakers. A reliability analysis was conducted on 20 elderly randomly selected patients. Two clinical pharmacists calculated the MRCI-E from discharge treatments and 2 months later. For the validity analysis, the sample was augmented to 60 patients. Convergent validity was assessed by analyzing the correlation between the number of medications; discriminant validity was stratified by gender; and predictive validity was determined by analyzing the ability to predict readmission and mortality at 3 and 6 months. Results: The MRCI-E retained the original structure of 3 sections. The reliability analysis demonstrated an excellent internal consistency (Cronbach’s α=0.83), and the intraclass correlation coefficient exceeded 0.9 in all cases. The correlation coefficient with the number of medications was 0.883 ( P<0.001). No significant differences were found when stratified by gender (3.6; 95%CI=−2.9 to 10.2; P=0.27). Patients who were readmitted at 3 months had a higher MRCI-E score (10.7; 95%CI=4.4 to 17.2; P=0.001). The differences remained significant in patients readmitted at 6 months, but differences in mortality were not detected. Conclusions: The MRCI-E retains the reliability and validity of the original index and provides a suitable tool to assess the complexity of medication regimens in Spanish.