Skip to main content
SpringerLink
Log in

Development of medication regimen complexity index: Japanese version and application in elderly patients

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Medication regimen complexity includes various aspects of a regimen, including the dosage form, number of medications and need for additional information for use. Complicated medication regimens cause non-adherence to prescribed medications, making it essential to evaluate medication regimen complexity in older adults to improve adherence to prescribed medications and clinical outcomes. The medication regimen complexity index is currently the most widely used scale for quantifying regimen complexity; however, it has yet to be adopted in Japan. Objective This study aimed to translate the medication regimen complexity index to Japanese and assess its reliability and validity for application in elderly patients in Japan. Setting This study was conducted in a clinic that provides home medical care to patients in the southern part of Ibaraki prefecture, Japan. Method The validation process consisted of translation of the original English version of the medication regimen complexity index to Japanese followed by back-translation to English, comparison of the back-translated and original versions, pilot testing, and assessment of the Japanese version by two raters using the medication regimens of 72 patients with chronic diseases. Main outcome measure The psychometric properties of the index were evaluated according to inter-rater and test-retest reliability, and convergent and discriminant validity. Results The mean age of the 72 patients was 84.3 years. The scale showed high inter-rater reliability (intraclass correlation coefficient 0.946) and test-retest reliability (intraclass correlation coefficient 0.991) for total scores. The number of medications was positively correlated with total medication regimen complexity index score (rs = 0.930, P < 0.001). There were no statistically significant differences between age, sex and Charlson Comorbidity Index and medication regimen complexity index score (P > 0.05). Conclusions The Japanese version of the medication regimen complexity index is a reliable and valid tool for assessing the complexity of medication regimen in Japanese elderly patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10:430–9.

    Article  Google Scholar 

  2. Fried TR, O’Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014;62:2261–72.

    Article  Google Scholar 

  3. Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, et al. Clinical outcomes associated with medication regimen complexity in older people: a systematic review. J Am Geriatr Soc. 2017;65:747–53.

    Article  Google Scholar 

  4. Pantuzza LL, Ceccato M, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol. 2017;73:1475–89.

    Article  Google Scholar 

  5. Wimmer BC, Dent E, Visvanathan R, Wiese MD, Johnell K, Chapman I, et al. Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: a prospective cohort study. Drugs Aging. 2014;31:623–30.

    Article  Google Scholar 

  6. Alves-Conceicao V, Rocha KSS, Silva FVN, Silva ROS, Silva DTD, Lyra-Jr DP. Medication regimen complexity measured by MRCI: a systematic review to identify health outcomes. Ann Pharmacother. 2018;52:1117–34.

    Article  Google Scholar 

  7. Wimmer BC, Bell JS, Fastbom J, Wiese MD, Johnell K. Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: a population-based cohort study. Ann Pharmacother. 2016;50:89–95.

    Article  Google Scholar 

  8. George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38:1369–76.

    Article  Google Scholar 

  9. Okuyan B, Babi B, Sancar M, Ay P, Yucel E, Yucel A, et al. Validation of the Turkish version of medication regimen complexity index among elderly patients. J Eval Clin Pract. 2016;22:732–6.

    Article  Google Scholar 

  10. Pantuzza LL, Ceccato M, Silveira MR, Pinto IV, Reis AMM. Validation and standardization of the Brazilian version of the medication regimen complexity Index for older adults in primary care. Geriatr Gerontol Int. 2018;18:853–9.

    Article  Google Scholar 

  11. Melchiors AC, Correr CJ, Fernandez-Llimos F. Translation and validation into Portuguese language of the medication regimen complexity index. Arq Bras Cardiol. 2007;89:210–8.

    Article  Google Scholar 

  12. de la SaezFuente J, Such Diaz A, Canamares-Orbis I, Ramila E, Izquierdo-Garcia E, Esteban C, et al. Cross-cultural adaptation and validation of the medication regimen complexity index adapted to Spanish. Ann Pharmacother. 2016;50:918–25.

    Article  Google Scholar 

  13. Stange D, Kriston L, Langebrake C, Cameron LK, Wollacott JD, Baehr M, et al. Development and psychometric evaluation of the German version of the medication regimen complexity index (MRCI-D). J Eval Clin Pract. 2012;18:515–22.

    Article  Google Scholar 

  14. Lee S, Jang J, Yang S, Hahn J, Min KL, Jung EH, et al. Development and validation of the Korean version of the medication regimen complexity index. PLoS ONE. 2019;14(5):e0216805.

    Article  CAS  Google Scholar 

  15. National Institute of Population and Social Security Research in Japan. Population projections for Japan. (2017): 2016–2065. http://www.ipss.go.jp/pp-zenkoku/e/zenkoku_e2017/pp29_summary.pdf. Accessed April 25, 2020.

  16. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.

    Article  CAS  Google Scholar 

  17. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  18. Koo TK, Li MY. A guideline of selecting and reporting Intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–63.

    Article  Google Scholar 

  19. Chan YH. Biostatistics 104: correlational analysis. Singap Med J. 2003;44:614–9.

    CAS  Google Scholar 

  20. Ferreira JM, Galato D, Melo AC. Medication regimen complexity in adults and the elderly in a primary healthcare setting: determination of high and low complexities. Pharm Pract (Granada). 2015;13(4):659.

    Article  Google Scholar 

  21. Alves-Conceicao V, Silva DTD, Santana VL, Santos EGD, Santos LMC, Lyra DP Jr. Evaluation of pharmacotherapy complexity in residents of long-term care facilities: a cross-sectional descriptive study. BMC Pharmacol Toxicol. 2017;18(1):59.

    Article  Google Scholar 

  22. Elliott RA, O’Callaghan C, Paul E, George J. Impact of an intervention to reduce medication regimen complexity for older hospital inpatients. Int J Clin Pharm. 2013;35:217–24.

    Article  Google Scholar 

  23. Chang WT, Kowalski SR, Sorich W, Alderman CP. Medication regimen complexity and prevalence of potentially inappropriate medicines in older patients after hospitalisation. Int J Clin Pharm. 2017;39:867–73.

    Article  CAS  Google Scholar 

  24. Mansur N, Weiss A, Beloosesky Y. Looking beyond polypharmacy: quantification of medication regimen complexity in the elderly. Am J Geriatr Pharmacother. 2012;10:223–9.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Johnson George, the developer of the original version of the MRCI, for providing permission to translate the MRCI to Japanese.

Funding

This study was supported by JSPS Grant-in-Aid for Scientific Research Grant Number 19K16940.

Author information

Authors and Affiliations

  1. Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan

    Shoichi Masumoto

  2. Department of General Medicine, Tsukuba Central Hospital, Ushiku, Japan

    Shoichi Masumoto

  3. Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan

    Mikiya Sato

  4. Health Services Center, Human Resources Group, Sumitomo Heavy Industries, Ltd., Tokyo, Japan

    Mikiya Sato

  5. Department of Pharmacy, Showa University Hospital, Tokyo, Japan

    Kenji Momo, Kosuke Suzuki, Hiroshi Shimamura & Tadanori Sasaki

  6. Welcia Yakkyoku Co. Ltd., Tokyo, Japan

    Aya Matsushita

  7. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Jun Hamano

Authors
  1. Shoichi Masumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikiya Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenji Momo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aya Matsushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kosuke Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Shimamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tadanori Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Hamano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shoichi Masumoto.

Ethics declarations

Conflicts of Interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Masumoto, S., Sato, M., Momo, K. et al. Development of medication regimen complexity index: Japanese version and application in elderly patients. Int J Clin Pharm 43, 858–863 (2021). https://doi.org/10.1007/s11096-020-01185-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01185-z

Keywords

Search

Navigation