Complexity index predicts drug doses in children with severe neurological disorders

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September 10, 2021

2 minutes to read

Disclosures: Feinstein claims to be chair of the Colorado State Pharmacy and Medicaid Therapy Committee. Please see the study for relevant financial information from all other authors.


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Children with severe neurological conditions who had higher scores on the drug regimen complexity index were more likely to receive significantly more doses of medication per day from their parents, according to a cross-sectional study.

“The Drug Regimen Complexity Index (MRCI) is a validated tool that assesses the complexity of drug regimens in adult and geriatric populations with polypharmacy, and it has the potential to be extrapolated to the pediatric population.” James A. Feinstein, MD, MPH, of the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado and Colorado Children’s Hospital, and colleagues wrote in JAMA network open. “The MRCI score is intended to differentiate, for example, between a lower complexity patient taking 10 drugs, each as a single pill with a daily dose, and a higher complexity patient taking 10 drugs, but each with dosage forms and requiring multiple doses per day. The total MRCI score is made up of [three] sub-scores calculated from the commonly available elements of patients’ drug prescriptions: dosage form, frequency of doses and specialized instructions.

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According to the researchers, MRCI scores can identify adult patients most likely to benefit from pharmacist-led drug therapy management programs, and they can also help estimate subsequent healthcare use and adverse events related to pharmacists. medications. In the present study, they aimed to use the MRCI to identify, measure and understand complex pediatric treatment regimens in 123 children aged 1 to 18 years with severe neurological disorders who were prescribed five or more drugs (59.3% of boys; median age 9).

Feinstein and his colleagues conducted the study between April 2019 and December 2020 in a large, single-center, inpatient complex care clinic. They classified the MRCI scores into low, medium, and high tertiles, which they used to analyze the number of sub-score features and additional patient-level safety variables. Poisson regression adjusted for age, complex chronic diseases, and recent health care use tested the correlations between groups of MRCI scores and acute visits.

The results showed median MRCI scores of 46 overall, 29 for the low group, 46 for the medium group and 69 for the high group, as well as median sub-scores of six dosage forms per patient, seven frequencies of dose per patient and five instructions per patient; counts increased significantly in the higher MRCI groups. Feinstein and colleagues observed similar trends for total daily dose (median = 31 doses), high-alert drugs (median = three drugs), and potential drug interactions (median = three interactions). They noted that the IRRs of the 30-day acute visits were 1.26 times higher (95% CI, 0.57-2.78) in the mean MRCI group compared to the low MRCI group and 2.42 times higher. high (95% CI, 1.1 to 5.35) in the high MRCI group compared to the low MRCI group.

“These results suggest that clinical interventions to manage [complex medication regimens] could target various aspects of these treatment regimens, such as simplifying dosing regimens, ”Feinstein and colleagues wrote.


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