Patient-Level Medication Regimen Complexity in Patients With HIV

Area of Science:

• Pharmacoeconomics
• HIV/AIDS Research
• Medication Adherence Studies

Background:

• Patients with HIV often manage multiple medications beyond antiretrovirals (ARVs).
• Medication regimen complexity, encompassing formulations, dosing, and directions, increases pill burden and impacts self-care.
• Existing research shows an inverse relationship between ARV adherence and ARV medication complexity, but complexity beyond ARVs remains uncharacterized.

Purpose of the Study:

• To quantify and describe the Patient-level Medication Regimen Complexity Index (pMRCI) and the Antiretroviral Medication Regimen Complexity Index (ARCI) in two HIV clinics.
• To test the hypothesis that an all-medication complexity metric (pMRCI) would exceed disease-specific metrics (ARCI) and that pMRCI would be lower than ARCI for ARVs alone.
• To evaluate the contribution of different medication types and dosing characteristics to overall regimen complexity.

Main Methods:

• A retrospective analysis of electronic health records for a random sample of 200 adult patients with HIV.
• Medication lists were used to calculate the pMRCI for all prescribed drugs.
• A subsample of 66 patients had their ARV regimens specifically coded using the ARCI.

Main Results:

• Patient medication counts ranged from 1 to 27, with pMRCI scores varying from 2 to 67.5.
• Non-ARV prescriptions accounted for approximately 66% of the pMRCI, while ARVs contributed about 25%.
• Dosing frequency was the most significant contributor to pMRCI, accounting for 62% of the complexity; pMRCI and ARCI scores for ARVs did not differ significantly.

Conclusions:

• Unique dosing frequencies significantly increase medication complexity and present intervention opportunities.
• The substantial contribution of non-ARV medications to pMRCI highlights the need for HIV management programs to review all patient prescriptions.
• A patient-level approach to medication complexity provides valuable insights, suggesting future research should explore the association between pMRCI, adherence, and patient outcomes.