Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA.
J Am Pharm Assoc (2003). 2013 Jul-Aug;53(4):427-31. doi: 10.1331/JAPhA.2013.13003.
To compare medication regimen complexity (MRC) for patients with uncontrolled hypertension, uncontrolled diabetes, or both, to examine the contribution of complexity components (dosage form, frequency, additional directions) to total MRC index (MRCI) score, and to explore the relationship of MRC with patient characteristics and medication regimen cost.
This cross-sectional retrospective study used electronic medical record data for patients' most recent visit to a university internal medicine clinic during 2009. MRCI scores (disease specific and patient level [medications for all conditions]) were calculated for adults with uncontrolled hypertension, diabetes, or both (i.e., not at recommended treatment goals).
206 patients (85 with hypertension, 60 with diabetes, and 61 with both) were included. The median (range) disease-specific MRCI was significantly greater for diabetes (8.0 [3-21]) than for hypertension (3.0 [2-11], P < 0.001), though the median number of disease-specific medications was identical (2). The majority of hypertension MRC was the result of dosage frequency (62.1%), while diabetes MRC was distributed among dosage form (38.3%), frequency (39.1%), and additional directions (27.6%). The median patient-level MRCI scores for each group were 11 to 15 points higher than the disease-specific MRCI scores. Higher MRCI scores were associated with higher regimen cost, comorbidity burden, and female gender.
The magnitude of MRCI scores varied across the three disease groups, increased dramatically when all medications were considered, and revealed greater complexity than a simple count of prescribed medications. The MRCI may be a useful tool for targeting patients for whom medication therapy management services would be most beneficial and cost effective.
比较未控制高血压、未控制糖尿病或两者并存患者的药物治疗方案复杂性（MRC），考察复杂性成分（剂型、频率、附加说明）对总 MRC 指数（MRCI）评分的贡献，并探讨 MRC 与患者特征和药物治疗方案费用的关系。
本回顾性横断面研究使用了 2009 年患者最近一次到大学内科诊所就诊的电子病历数据。计算了未控制高血压、糖尿病或两者并存（即未达到推荐治疗目标）患者的特定疾病和患者水平（所有疾病的药物治疗）的 MRCI 评分。
共纳入 206 例患者（高血压 85 例，糖尿病 60 例，两者并存 61 例）。特定疾病的 MRCI 中位数（范围）糖尿病显著大于高血压（8.0[3-21]比 3.0[2-11]，P<0.001），尽管特定疾病药物的中位数数量相同（2）。高血压 MRC 的大部分源于剂量频率（62.1%），而糖尿病 MRC 分布于剂型（38.3%）、频率（39.1%）和附加说明（27.6%）。每组患者水平的 MRCI 评分中位数比特定疾病的 MRCI 评分高 11 到 15 分。较高的 MRCI 评分与较高的治疗方案费用、合并症负担和女性性别有关。
MRCI 评分在三组疾病中变化幅度不同，当考虑所有药物时会显著增加，并且比简单计数处方药物更为复杂。MRCI 可能是一种有用的工具，可用于确定药物治疗管理服务最受益和最具成本效益的患者。
