Medication Complexity, Medication Number, and Their Relationships to Medication Discrepancies

Area of Science:

• Pharmacology
• Patient Safety
• Health Informatics

Background:

• Medication reconciliation is crucial for patient safety, aiming to identify and resolve medication discrepancies.
• Increasing medication counts and regimen complexity are linked to higher rates of discrepancies, nonadherence, and adverse drug events.
• The Medication Regimen Complexity Index (MRCI) quantifies regimen complexity by considering dosage form, frequency, and administration instructions.

Purpose of the Study:

• To evaluate the association between Medication Regimen Complexity Index (MRCI) scores and the number of medications with medication discrepancies.
• To specifically assess the relationship of MRCI scores and medication count with medication commissions, a type of discrepancy.

Main Methods:

• A retrospective cohort study analyzed 104 ambulatory care patients from the Department of Veterans Affairs.
• Medication discrepancies and commissions were primary outcomes, while MRCI scores and medication number served as primary exposures.
• Multivariable logistic regression and Receiver Operating Characteristic (ROC) curves were employed to analyze associations and identify thresholds.

Main Results:

• The median MRCI score was 25, and the median medication number was 8; 60% of patients experienced discrepancies, with 36% having commissions.
• Higher MRCI scores (≥25) and medication numbers (≥8) were significantly associated with increased odds of medication commissions.
• ROC analysis suggested thresholds of MRCI 36 and medication number 9 for identifying commissions, with varying sensitivity and specificity.

Conclusions:

• Patients with MRCI scores of 25 or higher, or 8 or more medications, face a greater likelihood of medication commissions.
• The number of medications, due to its simplicity and efficiency, is a practical metric for identifying patients requiring intensive medication review.