Evaluation of Hospital Discharge Prescriptions in the Elderly and Younger Adults Using the Medication Regimen Complexity Index

Author(s): Sujit Balodiya, Ashwin Kamath*.

Journal Name: Current Drug Safety

Volume 14 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Background: Advances in the clinical management of diseases have been accompanied by increasing complexity of treatment regimens. The complexity of medication regimen is of concern for patients as well as doctors as it may adversely affect patient compliance and treatment outcomes. It may result in medication errors, increased utilization of health resources owing to a reduction in treatment effectiveness, and increased risk of therapeutic failure.

Objective: This study aimed to assess the complexity of medication regimen prescribed to patients on hospital discharge using the medication regimen complexity index (MRCI).

Methods: A cross-sectional, descriptive study was conducted. Hospital discharge prescriptions written for patients discharged from the General Medicine wards of a tertiary care teaching hospital in South India were scored for their complexity using MRCI. The correlation of age and gender with the MRCI scores was also assessed. Patients ≥60 years of age were considered elderly.

Results: The median MRCI score for 563 prescriptions studied was 14 (Interquartile range, 9−21). Elderly patients received a significantly more complex medication regimen compared with younger patients (p < 0.001) at the time of hospital discharge. Gender variation was seen with higher MRCI scores in females, but this was not statistically significant in the elderly group.

Conclusion: MRCI scores are significantly high in elderly patients at the time of hospital discharge. Although a strong correlation is seen between the number of medications and the MRCI score, the latter helps to distinguish regimen complexity between prescriptions with the same number of medications.

Keywords: Medication regimen, prescription, elderly, gender, age, drug.

Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: The challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing 2013; 42: 62-9.
Brown MT, Bussell JK. Medication adherence: Who cares? Mayo Clin Proc 2011; 86(4): 304-14.
Abou-Karam N, Bradford C, Lor KB, Barnett M, Ha M, Rizos A. Medication regimen complexity and readmissions after hospitalization for heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease. SAGE Open Med 2016; 4: 2050312116632426.
Coleman EA, Berenson RA. Lost in transition: Challenges and opportunities for improving the quality of transitional care. Ann Intern Med 2004; 141(7): 533-6.
Makaryus AN, Friedman EA. Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 2005; 80(8): 991-4.
Kripalani S, Price M, Vigil V, Epstein KR. Frequency and predictors of prescription-related issues after hospital discharge. J Hosp Med 2008; 3(1): 12-9.
Wimmer BC, Bell JS, Fastbom J, Wiese MD, Johnell K. Medication regimen complexity and number of medications as factors associated with unplanned hospitalizations in older people: A population-based cohort study. J Gerontol A Biol Sci Med Sci 2016; 71(6): 831-7.
George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother 2004; 38: 1369-76.
Libby AM, Fish DN, Hosokawa PW, et al. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther 2013; 35(4): 385-98.
Hirsch JD, Metz KR, Hosokawa PW, Libby AM. Validation of a patient-level medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy 2014; 34(8): 826-35.
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): 750-6.
Lalic S, Jamsen KM, Wimmer BC, et al. Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: A cross-sectional study. Eur J Clin Pharmacol 2016; 72(9): 1117-24.
Ferreira JM, Galato D, Melo AC. Medication regimen complexity in adults and the elderly in a primary healthcare setting: Determination of high and low complexities. Pharm Pract (Granada) 2015; 13(4): 659.
Elliott RA, Callaghan CJO. Impact of hospitalisation on the complexity of older patients’ medication regimens and potential for regimen simplification. J Pharm Pract Res 2011; 41: 21-5.
Wimmer BC, Johnell K, Fastbom J, Wiese MD, Bell JS. Factors associated with medication regimen complexity in older people: A cross-sectional population-based study. Eur J Clin Pharmacol 2015; 71(9): 1099-108.
Schoonover H, Corbett CF, Weeks DL, Willson MN, Setter SM. Predicting potential postdischarge adverse drug events and 30-day unplanned hospital readmissions from medication regimen complexity. J Patient Saf 2014; 10(4): 186-91.
Mansur N, Weiss A, Beloosesky Y. Looking beyond polypharmacy: Quantification of medication regimen complexity in the elderly. Am J Geriatr Pharmacother 2012; 10(4): 223-9.
Patel CH, Zimmerman KM, Fonda JR, Linsky A. Medication complexity, medication number, and their relationships to medication discrepancies. Ann Pharmacother 2016; 50(7): 534-40.
Wimmer BC, Dent E, Bell JS, et al. Medication regimen complexity and unplanned hospital readmissions in older people. Ann Pharmacother 2014; 48(9): 1120-8.
Wimmer BC, Dent E, Visvanathan R, et al. Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: A prospective cohort study. Drugs Aging 2014; 31(8): 623-30.
Wimmer BC, Bell JS, Fastbom J, Wiese MD, Johnell K. Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: A population-based cohort study. Ann Pharmacother 2016; 50(2): 89-95.
Calvo-Cidoncha E, González-Bueno J, Almeida-González CV, Morillo-Verdugo R. Influence of treatment complexity on adherence and incidence of blips in HIV/HCV coinfected patients. J Manag Care Spec Pharm 2015; 21(2): 153-7.
Bjerrum L, Søgaard J, Hallas J, Kragstrup J. Polypharmacy: Correlations with sex, age and drug regimen. A prescription database study. Eur J Clin Pharmacol 1998; 54(3): 197-202.
Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: Results of the Kuopio 75+ study: A cross-sectional analysis. Drugs Aging 2009; 26(6): 493-503.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [116 - 121]
Pages: 6
DOI: 10.2174/1574886314666181207105118
Price: $65

Article Metrics

PDF: 62