Automation of the Medication Regimen May Improve Compliance

Difficulties in taking medicines are impacted by more than just the number of pills patients take, according to a new AHRQ-supported study. How often a medication is taken, whether the dose is always the same, and whether the medicine it is administered by mouth, through a shot, or through a patch, all have an impact on patients’ ability to follow their doctors’ or nurses’ instructions. Researchers had previously developed a medication regimen complexity index (MRCI) to help health care teams calculate the difficulty of their patients’ medicine schedules. A recent study suggests that researchers may be able to use computers to automatically tabulate the difficulty of following medication instructions. Automated calculations would allow health care teams to identify patients who are at higher risk of adverse events and could potentially be used to improve medication management and patient outcomes. Select to access the study, “Automating the Medication Regimen Complexity Index,” published online December 25, 2012 in the Journal of the American Medical Informatics Association.

Research and applications

Automating the medication regimen complexity index

+ Author Affiliations

¹Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
²Department of Nursing, College of Nursing and Health Science, University of Massachusetts Boston, Boston, Massachusetts, USA
³VNSNY CHOICE, Visiting Nurse Service of New York, New York, New York, USA
⁴Department of Medicine and Health Policy Institute, Medical College of Wisconsin, Madison, Wisconsin, USA

Correspondence to Margaret V McDonald, Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th floor, New York, NY 10001, USA; margaret.mcdonald@vnsny.org

Received 14 August 2012
Revised 26 November 2012
Accepted 2 December 2012
Published Online First 25 December 2012

Abstract

Objective To adapt and automate the medication regimen complexity index (MRCI) within the structure of a commercial medication database in the post-acute home care setting.

Materials and Methods In phase 1, medication data from 89 645 electronic health records were abstracted to line up with the components of the MRCI: dosage form, dosing frequency, and additional administrative directions. A committee reviewed output to assign index weights and determine necessary adaptations. In phase 2 we examined the face validity of the modified MRCI through analysis of automatic tabulations and descriptive statistics.

Results The mean number of medications per patient record was 7.6 (SD 3.8); mean MRCI score was 16.1 (SD 9.0). The number of medications and MRCI were highly associated, but there was a wide range of MRCI scores for each number of medications. Most patients (55%) were taking only oral medications in tablet/capsule form, although 16% had regimens with three or more medications with different routes/forms. The biggest contributor to the MRCI score was dosing frequency (mean 11.9). Over 36% of patients needed to remember two or more special instructions (eg, take on alternate days, dissolve).

Discussion Medication complexity can be tabulated through an automated process with some adaptation for local organizational systems. The MRCI provides a more nuanced way of measuring and assessing complexity than a simple medication count.

Conclusions An automated MRCI may help to identify patients who are at higher risk of adverse events, and could potentially be used in research and clinical decision support to improve medication management and patient outcomes.