Metz Kelli R, Fish Douglas N, Hosokawa Patrick W, Hirsch Jan D, Libby Anne M
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
Ann Pharmacother. 2014 Sep;48(9):1129-1137. doi: 10.1177/1060028014539642. Epub 2014 Jun 17.
Patients with HIV often have multiple medications besides antiretrovirals (ARV). Medication regimen complexity-formulations, dosing frequencies, and additional directions-expands pill burden by considering self-care demands. Studies show an inverse association between ARV adherence and medication complexity for ARVs only. Patient-level medication regimen complexity beyond ARV complexity is unknown.
To measure and characterize Patient-level Medication Regimen Complexity Index (pMRCI) and Antiretroviral Medication Regimen Complexity Index (ARCI) for patients in 2 HIV clinics. We hypothesized that an all-medication complexity metric will exceed disease-state-defined complexity metrics; for ARVs only, the pMRCI score will be smaller than the ARCI score by capturing fewer features of regimens. Associations between complexity and adherence were not assessed.
Electronic records supplied a retrospective, random sample of adult patients with HIV; medication lists were used to code the pMRCI (n=200). A random subsample (n=66) was coded using ARCI for ARV regimens only.
Medication counts ranged from 1 to 27; pMRCI scores ranged from 2 to 67.5. ARVs contributed roughly 25% to the pMRCI; other prescriptions contributed about 66%. Dosing frequency made the largest contribution of all components (62%) to the pMRCI. For ARVs, pMRCI and ARCI scores did not differ statistically.
Unique dosing frequencies raised complexity and may provide opportunities for intervention. Other prescriptions drove pMRCI scores, suggesting that HIV management programs should review all medications. A patient-level approach added value to understanding the role of medications in patient complexity; future work can assess association of pMRCI with adherence and patient outcomes.
感染HIV的患者除了抗逆转录病毒药物（ARV）外，通常还服用多种药物。药物治疗方案的复杂性——剂型、给药频率和其他说明——通过考虑自我护理需求增加了药丸负担。研究表明，仅就ARV而言，ARV依从性与药物治疗方案复杂性呈负相关。超出ARV复杂性的患者层面药物治疗方案复杂性尚不清楚。
测量并描述两家HIV诊所患者的患者层面药物治疗方案复杂性指数（pMRCI）和抗逆转录病毒药物治疗方案复杂性指数（ARCI）。我们假设，一个全药物复杂性指标将超过疾病状态定义的复杂性指标；仅就ARV而言，pMRCI分数将小于ARCI分数，因为它捕捉的治疗方案特征较少。未评估复杂性与依从性之间的关联。
电子记录提供了成年HIV患者的回顾性随机样本；用药清单用于对pMRCI进行编码（n = 200）。仅对ARV治疗方案使用ARCI对一个随机子样本（n = 66）进行编码。
药物数量从1到27不等；pMRCI分数从2到67.5不等。ARV对pMRCI的贡献约为25%；其他处方约占66%。给药频率对pMRCI所有组成部分的贡献最大（62%）。就ARV而言，pMRCI和ARCI分数在统计学上没有差异。
独特的给药频率增加了复杂性，可能提供干预机会。其他处方推动了pMRCI分数，这表明HIV管理项目应审查所有药物。患者层面的方法为理解药物在患者复杂性中的作用增加了价值；未来的工作可以评估pMRCI与依从性和患者结局之间的关联。
