Patel Chirag H, Zimmerman Kristin M, Fonda Jennifer R, Linsky Amy
MCPHS University, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA.
MCPHS University, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
Ann Pharmacother. 2016 Jul;50(7):534-40. doi: 10.1177/1060028016647067. Epub 2016 May 4.
Medication reconciliation to identify discrepancies is a National Patient Safety Goal. Increasing medication number and complex medication regimens are associated with discrepancies, nonadherence, and adverse events. The Medication Regimen Complexity Index (MRCI) integrates information about dosage form, dosing frequency, and additional directions.
This study evaluates the association of MRCI scores and medication number with medication discrepancies and commissions, a discrepancy subtype.
This was a retrospective cohort study of a convenience sample of 104 ambulatory care patients seen from April 2010 to July 2011 within the Department of Veterans Affairs. Primary outcomes included any medication discrepancy and commissions. Primary exposures included MRCI scores and medication number. Multivariable logistic regression models associated MRCI scores and medication number with discrepancies. Receiver operating characteristic (ROC) curves provided discrepancy thresholds.
For the 104 patients analyzed, the median MRCI score was 25 (interquartile range [IQR] = 14-43), and the median medication number was 8 (IQR = 5-13); 60% of patients had any discrepancy, whereas 36% had a commission. In adjusted analyses, patients with MRCI scores ≥25 or medication number ≥8 were more likely to have commissions (odds ratio [OR] = 3.64, 95% CI = 1.41-9.41; OR = 4.51, 95% CI = 1.73-11.73, respectively). The unadjusted ROC threshold for commissions was 36 for MRCI (sensitivity, 59%; specificity, 82%) and 9 for medication number (sensitivity 68%; specificity 67%).
Patients with either MRCI scores ≥25 or ≥8 medications were more likely to have commissions. Given equal performance in predicting discrepancies, the efficiency and simplicity of medication number supports its use in identifying patients for intensive medication review beyond medication reconciliation.
进行用药核对以识别差异是一项全国患者安全目标。用药数量增加和用药方案复杂与差异、不依从及不良事件相关。用药方案复杂性指数（MRCI）整合了剂型、给药频率及其他说明的信息。
本研究评估MRCI评分和用药数量与用药差异及医嘱遗漏（一种差异亚型）之间的关联。
这是一项回顾性队列研究，对2010年4月至2011年7月在退伍军人事务部就诊的104例门诊患者的便利样本进行研究。主要结局包括任何用药差异和医嘱遗漏。主要暴露因素包括MRCI评分和用药数量。多变量逻辑回归模型将MRCI评分和用药数量与差异相关联。受试者操作特征（ROC）曲线提供差异阈值。
在分析的104例患者中，MRCI评分中位数为25（四分位间距[IQR]=14 - 43），用药数量中位数为8（IQR = 5 - 13）；60%的患者有任何差异，而36%的患者有医嘱遗漏。在调整分析中，MRCI评分≥25或用药数量≥8的患者更有可能出现医嘱遗漏（比值比[OR]=3.64，95%置信区间[CI]=1.41 - 9.41；OR = 4.51，95%CI = 1.73 - 11.73）。医嘱遗漏的未调整ROC阈值，MRCI为36（敏感性59%；特异性82%），用药数量为9（敏感性68%；特异性67%）。
MRCI评分≥25或服用≥8种药物的患者更有可能出现医嘱遗漏。鉴于在预测差异方面表现相当，用药数量的高效性和简便性支持其用于识别除用药核对之外还需进行强化用药审查的患者。
