Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review
Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE, MEDLINE, International Pharmaceutical s, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, hom...
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| Published in | Journal of the American Geriatrics Society (JAGS) Vol. 65; no. 4; pp. 747 - 753 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Wiley Subscription Services, Inc
01.04.2017
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Objectives
To systematically review clinical outcomes associated with medication regimen complexity in older people.
Design
Systematic review of EMBASE, MEDLINE, International Pharmaceutical s, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library.
Setting
Hospitals, home, and long‐term care.
Participants
English‐language peer‐reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants’ overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity.
Measurements
Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool.
Results
Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less‐complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self‐administration errors, caregiver medication administration hassles, hospital discharge to non‐home settings, postdischarge potential adverse drug events, all‐cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication‐ and health‐related problems, emergency department visits, or quality of life as rated by nursing staff.
Conclusion
Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate‐quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. |
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| AbstractList | OBJECTIVESTo systematically review clinical outcomes associated with medication regimen complexity in older people.DESIGNSystematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library.SETTINGHospitals, home, and long-term care.PARTICIPANTSEnglish-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity.MEASUREMENTSQuality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool.RESULTSSixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff.CONCLUSIONResearch into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE, MEDLINE, International Pharmaceutical s, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, home, and long‐term care. Participants English‐language peer‐reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants’ overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Measurements Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Results Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less‐complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self‐administration errors, caregiver medication administration hassles, hospital discharge to non‐home settings, postdischarge potential adverse drug events, all‐cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication‐ and health‐related problems, emergency department visits, or quality of life as rated by nursing staff. Conclusion Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate‐quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, home, and long-term care. Participants English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants’ overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Measurements Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Results Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Conclusion Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE,MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, home, and long-term care. Participants English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Measurements Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Results Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Conclusion Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. Objectives To systematically review clinical outcomes associated with medication regimen complexity in older people. Design Systematic review of EMBASE , MEDLINE , International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Setting Hospitals, home, and long‐term care. Participants English‐language peer‐reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants’ overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Measurements Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Results Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less‐complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self‐administration errors, caregiver medication administration hassles, hospital discharge to non‐home settings, postdischarge potential adverse drug events, all‐cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication‐ and health‐related problems, emergency department visits, or quality of life as rated by nursing staff. Conclusion Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate‐quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. To systematically review clinical outcomes associated with medication regimen complexity in older people. Systematic review of EMBASE, MEDLINE, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane library. Hospitals, home, and long-term care. English-language peer-reviewed original research published before June 2016 was eligible if regimen complexity was quantified using a metric that considered number of medications and at least one other parameter, regimen complexity was calculated for participants' overall regimen, at least 80% of participants were aged 60 and older, and the study investigated a clinical outcome associated with regimen complexity. Quality assessment was conducted using an adapted version of the Joanna Briggs Institute critical appraisal tool. Sixteen observational studies met the inclusion criteria. Regimen complexity was associated with medication nonadherence (2/6 studies) and higher rates of hospitalization (2/4 studies). One study found that participants with less-complex medication administration were more likely to stop medications when feeling worse. One study each identified an association between regimen complexity and higher ability to administer medications as directed, medication self-administration errors, caregiver medication administration hassles, hospital discharge to non-home settings, postdischarge potential adverse drug events, all-cause mortality, and lower patient knowledge of their medication. Regimen complexity had no association with postdischarge medication modification, change in medication- and health-related problems, emergency department visits, or quality of life as rated by nursing staff. Research into whether medication regimen complexity is associated with nonadherence and hospitalization has produced inconsistent results. Moderate-quality evidence from four studies (two each for nonadherence and hospitalization) suggests that medication regimen complexity is associated with nonadherence and higher rates of hospitalization. |
| Author | George, Johnson Wimmer, Barbara C Cross, Amanda J Wiese, Michael D Diug, Basia Jokanovic, Natali Johnell, Kristina Bell, J. Simon |
| Author_xml | – sequence: 1 givenname: Barbara C surname: Wimmer fullname: Wimmer, Barbara C email: barbara.wimmer@monash.edu organization: University of Tasmania – sequence: 2 givenname: Amanda J surname: Cross fullname: Cross, Amanda J organization: Monash University – sequence: 3 givenname: Natali surname: Jokanovic fullname: Jokanovic, Natali organization: Monash University – sequence: 4 givenname: Michael D surname: Wiese fullname: Wiese, Michael D organization: University of South Australia – sequence: 5 givenname: Johnson surname: George fullname: George, Johnson organization: Monash University – sequence: 6 givenname: Kristina surname: Johnell fullname: Johnell, Kristina organization: Karolinska Institutet and Stockholm University – sequence: 7 givenname: Basia surname: Diug fullname: Diug, Basia organization: Monash University – sequence: 8 givenname: J. Simon surname: Bell fullname: Bell, J. Simon organization: Monash University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27991653$$D View this record in MEDLINE/PubMed https://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-143619$$DView record from Swedish Publication Index http://kipublications.ki.se/Default.aspx?queryparsed=id:135677865$$DView record from Swedish Publication Index |
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| SubjectTerms | adherence Aged Cause of Death Clinical outcomes Comorbidity Drug administration Drug-Related Side Effects and Adverse Reactions Hospitalization Humans Medication Adherence Medication Errors medication regimen complexity Medicin och hälsovetenskap Middle Aged Older people Outcome Assessment (Health Care) Polypharmacy Quality Risk Factors Studies systematic review |
| Title | Clinical Outcomes Associated with Medication Regimen Complexity in Older People: A Systematic Review |
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