Complexity of the medication regimen for polypathological patients

To determine the complexity of the therapeutic regimen for polypathological patients hospitalised in internal medicine departments.

A multicentre observational study included polypathological patients hospitalised in internal medicine departments. Patients who were readmitted or died were excluded. Data were collected on age, sex, residence, disease, Charlson, Barthel and Lawton-Brody indices, Pfeiffer questionnaire, Gijón scale, number of hospitalisations in the previous year, delirium, need for and availability of caregivers and the PROFUND index score. We calculated the therapeutic complexity with the Medication Regimen Complexity Index (MRCI). We considered a therapeutic regimen complex when the MRCI score was in the fourth quartile. To determine the factors associated with complexity, we constructed a logistic regression model.

We included 233 polypathological patients, 52.9% of whom were women, with a mean age of 79.8 (SD: 8.6) years. The mean number of drugs consumed was 8.4 (SD: 3.3). The mean MRCI score was 30 (SD: 15.2). The MRCI score by quartiles was 0-20, 20.5-30, 30.5-42, 42.5-80. The respiratory diseases (OR: 4.185; 95%CI: 2.015-8.693; P<.001) were independently associated with increased therapeutic complexity, and the neurological diseases with permanent mental deficiency (OR: 0.265; 95%CI: 0.085-0.828; P=.022) were associated with less complexity.

Patients with comorbidities are polymedicated and have complex therapeutic drug regimens. Respiratory diseases determine greater therapeutic complexity, while cognitive impairment determines a lower therapeutic complexity.