Perspectives of Older Patients on the Complexity of Medication Use

Abstract

Background: Medication use complexity is associated with non-adherence, hospitalizations, and lower quality of life. It is most frequently measured with the Medication Regimen Complexity Index (MRCI). This instrument estimates the complexity of a patient's medication regimen, taking into account the pharmaceutical dosage forms and routes, dosage frequency, and instructions for use. This instrument was, however, developed without patient experience data and may overlook patient perspectives. Therefore, this study aimed to identify older patients' perspectives on medication use complexity. Methods: This qualitative study used semi-structured interviews among patients aged ≥ 70 years using ≥ 5 chronic medications, recruited at community pharmacies and a geriatric outpatient clinic. After medication reconciliation, open-ended questions about the patient's medication use and four hypothetical medication regimens with similar MRCI scores but different schemes were discussed. Interviews were transcribed verbatim and coded independently by two researchers. Inductive and deductive thematic analysis using NVivo was applied to explore themes influencing medication use complexity according to patients. Results: Sixteen patients were included (median age, 76; 56% female; median number of medications including OTC, 14). Four themes were identified, of which three are medication-related themes: medication characteristics, preparation for administration, and administration regimen. Factors that reduced medication use complexity included identification by medication appearance, use of medication aids or multidose drug dispensing systems, and development of routines. Factors that increased complexity included alterations in medication appearance or routine. The fourth theme was user-related and focused on the complexity of medication use in the context of an individual patient's attitudes and beliefs regarding medication and healthcare. Conclusion: This study identified many themes that can influence medication use complexity for older patients, including new themes beyond those measured by the MRCI. Individualized assessments may better address patient-specific challenges in medication use, ultimately enhancing the potential effectiveness of complexity-reducing interventions.