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Aksoy, N., Ozturk, N., Okuyan, B., & Sancar, M. (2023). Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients - Validation of the “MRCI-Arabic”. Sudan Journal of Medical Sciences (SJMS), 18(3), 311–324. https://doi.org/10.18502/sjms.v18i3.14086
https://doi.org/10.18502/sjms.v18i3.14086
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authors
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Nilay Aksoy
Nilay Aksoy
Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, Istanbul, Turkey
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Nur Ozturk
Nur Ozturk
Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, Istanbul, Turkey
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Betul Okuyan
Betul Okuyan
Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
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Mesut Sancar
Mesut Sancar
Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
Published Date
- Sep 27, 2023
Validation of the Arabic Version of Medication Regimen Complexity Index Among Older Patients - Validation of the “MRCI-Arabic”
Abstract
The medication regimen complexity index is widely used in clinical practice and many studies, to assess the complexity of medication regimens. The goal of this study is to validate the medication regimen complexity index-Arabic (MRCI-Arabic) version among older patients.
Methods: This methodologic study was conducted in older patients (≥ 65 years old) who were native Arabic speakers at a community pharmacy located in Istanbul, Turkey. After the translation and cultural adaptation process finished, medication regimens of 30 patients were evaluated for test-retest reliability three weeks apart by the rater who was a native Arabic speaker. The inter-rater correlation was calculated in study population (n =100). The link between the number of medications and the score of medication regimen complexity was used to assess convergent validity. The difference in the score of pharmaceutical regimen complexity in stratified age groups was used to examine discriminant validity.
Results: The inter-rater and test-retest reliability of the MRCI-Arabic total scale and its subsection were extremely high (Spearman’s rho ranged from 0.996 to 1; p <0.001). There was a strong and positive correlation between the total MRCI-Arabic score and the number of medications (r = 0.830; p < 0.001), the number of chronic diseases (r = 0.641; p < 0.001).
Conclusion: The Arabic validation of the MRCI is a validated tool that can be used by native Arabic-speaking healthcare professionals to determine the complexity of their patients’ medication regimens.
Keywords:
medication regimen complexity index, Arabic version, validation, older patients, clinical practice
References
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[19] Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122.
[20] Negewo, N. A., Gibson, P. G., Wark, P. A., Simpson, J. L., & McDonald, V. M. (2017). Treatment burden, clinical outcomes, and comorbidities in COPD: An examination of the utility of medication regimen complexity index in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2929.
[21] Viktil, K. K., Blix, H. S., Moger, T. A., & Reikvam, A. (2007). Polypharmacy as commonly defined is an indicator of limited value in the assessment of drugrelated problems. British Journal of Clinical Pharmacology, 63(2), 187-195.
[22] Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Jama, 287(3), 337-344.
[23] Fialová, D., Topinková, E., Gambassi, G., Finne-Soveri, H., Jónsson, P. V., Carpenter, I., Schroll, M., Onder, G., Sørbye, L. W., Wagner, Reissigová, J., Bernabei, R., AdHOC Project Research Group. (2005). Potentially inappropriate medication use among elderly home care patients in Europe. Jama, 293(11), 1348-1358.
[24] Stoehr, G. P., Ganguli, M., Seaberg, E. C., Echemen, D. A., & Belle, S. (1997). Overthecounter medication use in an older rural community: The Mo VIES Project. Journal of the American Geriatrics Society, 45(2), 158-165.
[25] Wimmer, B. C., Johnell, K., Fastbom, J., Wiese, M. D., & Bell, J. S. (2015). Factors associated with medication regimen complexity in older people: A cross-sectional population-based study. European Journal of Clinical Pharmacology, 71(9), 1099- 1108.
[26] Brysch, E. G., Cauthon, K. A., Kalich, B. A., & Sarbacker, G. B. (2018). Medication regimen complexity index in the elderly in an outpatient setting: A literature review. The Consultant Pharmacist®, 33(9), 484-496.
[27] Linnebur, S. A., Griend, J. P. V., Metz, K. R., Hosokawa, P. W., Hirsch, J. D., & Libby, A. M. (2014). Patient-level medication regimen complexity in older adults with depression. Clinical Therapeutics, 36(11), 1538-1546.
[28] McDonald, M. V., Peng, T. R., Sridharan, S., Foust, J. B., Kogan, P., Pezzin, L. E., & Feldman, P. H. (2013). Automating the medication regimen complexity index. Journal of the American Medical Informatics Association, 20(3), 499-505.
[29] Hirsch, J. D., Metz, K. R., Hosokawa, P. W., & Libby, A. M. (2014). Validation of a patientlevel medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(8), 826-835.
[30] Lalic, S., Jamsen, K. M., Wimmer, B. C., Tan, E. C., Hilmer, S. N., Robson, L., ... & Bell, J. S. (2016). Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: a crosssectional study. European Journal of Clinical Pharmacology, 72(9), 1117-1124.
[31] Wimmer, B. C., Dent, E., Visvanathan, R., Wiese, M. D., Johnell, K., Chapman, I., & Bell, J. S. (2014). Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: A prospective cohort study. Drugs & Aging, 31(8), 623-630.
[32] Wimmer, B. C., Dent, E., Bell, J. S., Wiese, M. D., Chapman, I., Johnell, K., & Visvanathan, R. (2014). Medication regimen complexity and unplanned hospital readmissions in older people. Annals of Pharmacotherapy, 48(9), 1120-1128.
[33] Wimmer, B. C., Bell, J. S., Fastbom, J., Wiese, M. D., & Johnell, K. (2016). Medication regimen complexity and number of medications as factors associated with unplanned hospitalizations in older people: a population-based cohort study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(6), 831-837.
[34] Lalic, S., Sluggett, J. K., Ilomäki, J., Wimmer, B. C., Tan, E. C., Robson, L., Emery, T., & Bell, J. S. (2016). Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective cohort study. Journal of the American Medical Directors Association, 17(11), 1067-e1-1067.e6.
[35] Wimmer, B. C., Bell, J. S., Fastbom, J., Wiese, M. D., & Johnell, K. (2016). Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: A population-based cohort study. Annals of Pharmacotherapy, 50(2), 89-95.
[2] Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC geriatrics, 17(1), 1-10.
[3] Advinha, A. M., de Oliveira-Martins, S., Mateus, V., Pajote, S. G., & Lopes, M. J. (2014). Medication regimen complexity in institutionalized elderly people in an aging society. International Journal of Clinical Pharmacy, 36(4), 750-756.
[4] De Geest, S., & Sabaté, E. (2003). Adherence to long-term therapies: evidence for action. European Journal of Cardiovascular Nursing, 2(4), 323-323.
[5] Jimmy, B., & Jose, J. (2011). Patient medication adherence: measures in daily practice. Oman Medical Journal, 26(3), 155.
[6] Wimmer, B. C., Cross, A. J., Jokanovic, N., Wiese, M. D., George, J., Johnell, K., Diug, D., & Bell, J. S. (2017). Clinical outcomes associated with medication regimen complexity in older people: A systematic review. Journal of the American Geriatrics Society, 65(4), 747-753.
[7] Alves-Conceicao, V., Rocha, K. S. S., Silva, F. V. N., Silva, R. O. S., Silva, D. T. D., & Lyra- Jr, D. P. D. (2018). Medication regimen complexity measured by MRCI: A systematic review to identify health outcomes. Annals of Pharmacotherapy, 52(11), 1117-1134.
[8] George, J., Phun, Y. T., Bailey, M. J., Kong, D. C., & Stewart, K. (2004). Development and validation of the medication regimen complexity index. Annals of Pharmacotherapy, 38(9), 1369-1376.
[9] Okuyan, B., Babi, B., Sancar, M., Ay, P., Yücel, E., Yücel, A., & Izzettin, F. V. (2016). Validation of the Turkish version of medication regimen complexity index among elderly patients. Journal of Evaluation in Clinical Practice, 22(5), 732-736.
[10] Saez de la Fuente, J., Such Diaz, A., Cañamares-Orbis, I., Ramila, E., Izquierdo- Garcia, E., Esteban, C., & Escobar-Rodríguez, I. (2016). Cross-cultural adaptation and validation of the medication regimen complexity index adapted to Spanish. Annals of Pharmacotherapy, 50(11), 918-925.
[11] Stange, D., Kriston, L., Langebrake, C., Cameron, L. K., Wollacott, J. D., Baehr, M., & Dartsch, D. C. (2012). Development and psychometric evaluation of the German version of the Medication Regimen Complexity Index (MRCID). Journal of Evaluation in Clinical Practice, 18(3), 515-522.
[12] Deliza, R., Rosenthal, A., & Costa, M. C. D. (2003). Tradução e validação para a língua portuguesa de questionário utilizado em estudos de consumidor. Food Science and Technology, 23, 43-48.
[13] Hahn, J., Lok Min, K., hee Jung, E., sun Oh, K., Cho, R., Jung Chang, M. (2019). Development and validation of the Korean version of the medication regimen complexity index. PLoS One,14, e0216805.
[14] Masumoto, S., Sato, M., Momo, K., Matsushita, A., Suzuki, K., Shimamura, H., Shimamura, H., & Hamano, J. (2021). Development of medication regimen complexity index: Japanese version and application in elderly patients. International Journal of Clinical Pharmacy, 43(4), 858-863.
[15] Masumoto, S., Sato, M., Momo, K., Matsushita, A., Suzuki, K., Shimamura, H., ... & Hamano, J. (2021). Development of medication regimen complexity index: Japanese version and application in elderly patients. International Journal of Clinical Pharmacy, 43(4), 858-863.
[16] Al-Qerem, W., Jarrar, Y. B., Al-Sheikh, I., & ElMaadani, A. (2018). The prevalence of drug-drug interactions and polypharmacy among elderly patients in Jordan. mortality, 15, 16.
[17] Al Qasem, A., Smith, F., & Clifford, S. (2011). Adherence to medication among chronic patients in Middle Eastern countries: Review of studies. EMHJ-Eastern Mediterranean Health Journal, 17(4), 356-363.
[18] Westberg, S. M., & Sorensen, T. D. (2005). Pharmacy-related health disparities experienced by Non–English-Speaking patients: Impact of pharmaceutical care. Journal of the American Pharmacists Association, 45(1), 48-54.
[19] Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2), e122.
[20] Negewo, N. A., Gibson, P. G., Wark, P. A., Simpson, J. L., & McDonald, V. M. (2017). Treatment burden, clinical outcomes, and comorbidities in COPD: An examination of the utility of medication regimen complexity index in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2929.
[21] Viktil, K. K., Blix, H. S., Moger, T. A., & Reikvam, A. (2007). Polypharmacy as commonly defined is an indicator of limited value in the assessment of drugrelated problems. British Journal of Clinical Pharmacology, 63(2), 187-195.
[22] Kaufman, D. W., Kelly, J. P., Rosenberg, L., Anderson, T. E., & Mitchell, A. A. (2002). Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Jama, 287(3), 337-344.
[23] Fialová, D., Topinková, E., Gambassi, G., Finne-Soveri, H., Jónsson, P. V., Carpenter, I., Schroll, M., Onder, G., Sørbye, L. W., Wagner, Reissigová, J., Bernabei, R., AdHOC Project Research Group. (2005). Potentially inappropriate medication use among elderly home care patients in Europe. Jama, 293(11), 1348-1358.
[24] Stoehr, G. P., Ganguli, M., Seaberg, E. C., Echemen, D. A., & Belle, S. (1997). Overthecounter medication use in an older rural community: The Mo VIES Project. Journal of the American Geriatrics Society, 45(2), 158-165.
[25] Wimmer, B. C., Johnell, K., Fastbom, J., Wiese, M. D., & Bell, J. S. (2015). Factors associated with medication regimen complexity in older people: A cross-sectional population-based study. European Journal of Clinical Pharmacology, 71(9), 1099- 1108.
[26] Brysch, E. G., Cauthon, K. A., Kalich, B. A., & Sarbacker, G. B. (2018). Medication regimen complexity index in the elderly in an outpatient setting: A literature review. The Consultant Pharmacist®, 33(9), 484-496.
[27] Linnebur, S. A., Griend, J. P. V., Metz, K. R., Hosokawa, P. W., Hirsch, J. D., & Libby, A. M. (2014). Patient-level medication regimen complexity in older adults with depression. Clinical Therapeutics, 36(11), 1538-1546.
[28] McDonald, M. V., Peng, T. R., Sridharan, S., Foust, J. B., Kogan, P., Pezzin, L. E., & Feldman, P. H. (2013). Automating the medication regimen complexity index. Journal of the American Medical Informatics Association, 20(3), 499-505.
[29] Hirsch, J. D., Metz, K. R., Hosokawa, P. W., & Libby, A. M. (2014). Validation of a patientlevel medication regimen complexity index as a possible tool to identify patients for medication therapy management intervention. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(8), 826-835.
[30] Lalic, S., Jamsen, K. M., Wimmer, B. C., Tan, E. C., Hilmer, S. N., Robson, L., ... & Bell, J. S. (2016). Polypharmacy and medication regimen complexity as factors associated with staff informant rated quality of life in residents of aged care facilities: a crosssectional study. European Journal of Clinical Pharmacology, 72(9), 1117-1124.
[31] Wimmer, B. C., Dent, E., Visvanathan, R., Wiese, M. D., Johnell, K., Chapman, I., & Bell, J. S. (2014). Polypharmacy and medication regimen complexity as factors associated with hospital discharge destination among older people: A prospective cohort study. Drugs & Aging, 31(8), 623-630.
[32] Wimmer, B. C., Dent, E., Bell, J. S., Wiese, M. D., Chapman, I., Johnell, K., & Visvanathan, R. (2014). Medication regimen complexity and unplanned hospital readmissions in older people. Annals of Pharmacotherapy, 48(9), 1120-1128.
[33] Wimmer, B. C., Bell, J. S., Fastbom, J., Wiese, M. D., & Johnell, K. (2016). Medication regimen complexity and number of medications as factors associated with unplanned hospitalizations in older people: a population-based cohort study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(6), 831-837.
[34] Lalic, S., Sluggett, J. K., Ilomäki, J., Wimmer, B. C., Tan, E. C., Robson, L., Emery, T., & Bell, J. S. (2016). Polypharmacy and medication regimen complexity as risk factors for hospitalization among residents of long-term care facilities: A prospective cohort study. Journal of the American Medical Directors Association, 17(11), 1067-e1-1067.e6.
[35] Wimmer, B. C., Bell, J. S., Fastbom, J., Wiese, M. D., & Johnell, K. (2016). Medication regimen complexity and polypharmacy as factors associated with all-cause mortality in older people: A population-based cohort study. Annals of Pharmacotherapy, 50(2), 89-95.