title: Impact of an intervention to reduce medication regimen complexity for older hospital inpatients.
abstract: BACKGROUND
  Hospitalisation often leads to increased medication regimen complexity for older patients; increased complexity is associated with medication non-adherence. There has been little research into strategies for reducing the impact of hospitalisation on medication regimen complexity.
  
  
  OBJECTIVE
  To investigate the impact of pharmacist medication review, together with an educational intervention targeting clinical pharmacists and junior medical officers, on the increase in medication regimen complexity that occurs during hospitalisation.
  
  
  METHODS
  Two acute general medicine wards and two subacute aged care (geriatric assessment and rehabilitation) wards at a major metropolitan public hospital in Melbourne, Australia.
  
  
  METHODS
  A before-after study involving patients aged 60 years and over was undertaken over two 5-week periods. During the pre-intervention period patients received usual care. During the intervention period, clinical pharmacists were encouraged to review patients' medication regimen complexity prior to discharge, and make recommendations to hospital medical officers to simplify regimens. Prior to the intervention period, pharmacists attended an interactive case-based education session about medication regimen simplification, and completed an assessment task. A similar, but briefer, education session was delivered to junior medical officers.
  
  
  METHODS
  The primary endpoint was change in medication regimen complexity index (MRCI) score (a validated measure of regimen complexity) between admission and discharge for regularly scheduled long-term medications, adjusted for age, length of hospital stay, number of medications and regimen complexity prior to admission.
  
  
  RESULTS
  Three hundred ninety-one patients were included (mean age 80.6 years, mean 7.4 regularly scheduled long-term medications on admission). The mean increase in MRCI score between admission and discharge was significantly smaller in the 205 intervention patients than in the 186 usual care patients (2.5 vs. 4.0, p = 0.02; adjusted difference 1.6, 95 %CI 0.3, 2.9). The intervention had greatest impact in patients discharged from subacute wards (mean adjusted difference: 2.7), not using a dose administration aid after discharge (mean adjusted difference: 2.6), and not discharged to a residential care facility (mean adjusted difference: 1.9). Mean differences in MRCI scores were equivalent to ceasing one to two medications.
  
  
  CONCLUSIONS
  An educational intervention and clinical pharmacist medication review reduced the impact of hospitalisation on the complexity of older patients' medication regimens.
authors.affiliation: Pharmacy Department, Austin Health, Studley Rd, Heidelberg, VIC, 3084, Australia. rohan.elliott@monash.edu
authors.forename: Rohan A
authors.initials: RA
authors.lastname: Elliott
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Callaghan
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Johnson
authors.initials: J
authors.lastname: George
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004513:Education, Pharmacy, Continuing / Q000379:methods; D005260:Female; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D007902:Length of Stay; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D013997:Time Factors; D014739:Victoria
chemical_list: D004364:Pharmaceutical Preparations