VA Boston Healthcare System , 150 South Huntington Avenue, Boston, MA 02130 , USA
Expert Opin Drug Saf. 2013 Nov;12(6):829-40. doi: 10.1517/14740338.2013.823944. Epub 2013 Aug 28.
Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes.
A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared.
Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.
复杂的药物治疗方案容易出错，且对患者具有挑战性，这可能会影响药物的依从性和安全性。目前还没有一种通用的方法来评估药物治疗方案的复杂性（CMRx）。作者旨在对评估药物治疗方案复杂性的文献进行综述，以确定一致性，并其次描述 CMRx 对医疗保健结果的影响。
对 EMBASE 和 PubMed 进行了检索，以查找至少分析两种药物和复杂性成分的研究，这些研究均为患者自行管理的药物。在 1204 篇摘要中，有 38 项研究最终被纳入样本。大多数（74%）研究使用了五种已验证的 CMRx 量表之一；比较了它们的成分和评分。
需要进行通用的 CMRx 评估，以识别和减少复杂的治疗方案，从而提高安全性。作者强调了五种量表之间的共同之处，以帮助达成共识。常见的成分（例如，剂量频率、每剂量单位和非口服途径）包括剂量频率、单位剂量和非口服途径。这些成分（例如，剂量频率）的元素（例如，每日两次）和评分有所不同。目前的量表没有考虑到患者特定的因素（例如，灵活性、认知能力），这是当前量表的一个缺点，也是未来量表的一个挑战。由于 CMRx 对重要的结果（特别是依从性和医疗保健利用）有影响，因此标准化工具具有广泛的临床、研究和患者安全影响的潜力。
