Complexity index predicts medication doses in kids with severe neurological impairment

Children with severe neurological impairment who had higher scores on the Medication Regimen Complexity Index were more likely to receive many more doses of medications per day from their parents, according to a cross-sectional study.

“The Medication Regimen Complexity Index (MRCI) is a validated tool that assesses medication regimen complexity in adult and geriatric populations with polypharmacy, and it has the potential to be extrapolated to the pediatric population,” James A. Feinstein, MD, MPH, of the Adult and Child Consortium for Health Outcomes Research and Delivery Science at the University of Colorado and Children’s Hospital Colorado, and colleagues wrote in JAMA Network Open. “The MRCI score is intended to differentiate, for example, between a patient with lower complexity taking 10 medications, each as a single pill with once-daily dosing, and a patient with higher complexity taking 10 medications, but each with different dosage forms and requiring multiple doses per day. The total MRCI score is composed of [three] sub-scores calculated from commonly available elements of patients’ medication prescriptions: dosage form, dose frequency and specialized instructions.”

According to the researchers, MRCI scores can pinpoint adult patients most likely to benefit from pharmacist-led medication therapy management programs, and they may also help estimate subsequent health care utilization and adverse drug events. In the current study, they aimed to use the MRCI to identify, measure and understand pediatric complex medication regimens among 123 children aged 1 to 18 years with severe neurological impairment who were prescribed five or more medications (59.3% boys; median age, 9 years).

Feinstein and colleagues conducted the study between April 2019 and December 2020 at a single-center, large, hospital-based, complex care clinic. They categorized MRCI scores into low, medium and high tertiles, which they used to analyze patient-level counts of sub-score characteristics and additional safety variables. Poisson regression adjusted for age, complex chronic conditions and recent health care use tested correlations between MRCI score groups and acute visits.

Results showed median MRCI scores of 46 overall, 29 for the low group, 46 for the medium group and 69 for the high group, as well as median sub-score counts of six dosage forms per patient, seven dose frequencies per patients and five instructions per patient; counts increased significantly across higher MRCI groups. Feinstein and colleagues observed similar trends for total daily dose (median = 31 doses), high-alert medications (median = three medications) and potential drug–drug interactions (median = three interactions). They noted IRRs of 30-day acute visits were 1.26 times greater (95% CI, 0.57-2.78) in the medium MRCI group compared with the low MRCI group and 2.42 times greater (95% CI, 1.1-5.35) in the high MRCI group compared with the low MRCI group.

“These findings suggest that clinical interventions to manage [complex medication regimens] could target various aspects of these regimens, such as the simplification of dosing schedules,” Feinstein and colleagues wrote.