title: Complexity perplexity: a systematic review to describe the measurement of medication regimen complexity.
abstract: BACKGROUND
  Complex medication regimens are error prone and challenging for patients, which may impact medication adherence and safety. No universal method to assess the complexity of medication regimens (CMRx) exists. The authors aim to review literature for CMRx measurements to establish consistencies and, secondarily, describe CMRx impact on healthcare outcomes.
  
  
  METHODS
  A search of EMBASE and PubMed for studies analyzing at least two medications and complexity components, among those self-managing medications, was conducted. Out of 1204 abstracts, 38 studies were included in the final sample. The majority (74%) of studies used one of five validated CMRx scales; their components and scoring were compared.
  
  
  CONCLUSIONS
  Universal CMRx assessment is needed to identify and reduce complex regimens, and, thus, improve safety. The authors highlight commonalities among five scales to help build consensus. Common components (i.e., regimen factors) included dosing frequency, units per dose, and non-oral routes. Elements (e.g., twice daily) of these components (e.g., dosing frequency) and scoring varied. Patient-specific factors (e.g., dexterity, cognition) were not addressed, which is a shortcoming of current scales and a challenge for future scales. As CMRx has important outcomes, notably adherence and healthcare utilization, a standardized tool has potential for far-reaching clinical, research, and patient-safety impact.
authors.affiliation: VA Boston Healthcare System , 150 South Huntington Avenue, Boston, MA 02130 , USA allison.paquin@va.gov.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Paquin
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Zimmerman
authors.forename: Tia R
authors.initials: TR
authors.lastname: Kostas
authors.forename: Lindsey
authors.initials: L
authors.lastname: Pelletier
authors.forename: Angela
authors.initials: A
authors.lastname: Hwang
authors.forename: Mark
authors.initials: M
authors.lastname: Simone
authors.forename: Lara M
authors.initials: LM
authors.lastname: Skarf
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
mesh_terms: D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D008508:Medication Errors / Q000517:prevention & control; D017063:Outcome Assessment, Health Care; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*
chemical_list: D004364:Pharmaceutical Preparations