Medication regimen complexity and the care of the chronically ill patient

Abstract

As the population in developed countries ages, patients with multiple chronic conditions are becoming more common. These patients are increasingly being managed with multiple concurrent medications and their medication regimens are frequently described as complex. Despite the significant challenges that complexity poses for clinical decision-making, the adherence of patients to their medication regimens and patient health and wellbeing, a robust understanding of this term in the context of medication regimens, is lacking. Here, it is shown that the essential feature of complex medication regimens is the multiplicity of rules that constitute their basic structure, rather than their intrinsic comprehensibility. Medication regimen complexity is a measure of the size of the consolidated medication script, or the shortest possible list of rules, for that medication regimen. A protocol is suggested for the consolidation of a medication regimen and the measurement and reduction of regimen complexity. This involves simplifying dosing instructions, consolidating the rules for taking medications, determining the number of rules in the consolidated medication script and eliminating or modifying rules towards a more parsimonious treatment plan. Following this protocolmay reduce the burden on the patient associated with adhering to the treatment regimen and thus promote patient-centred outcomes, such as improved health and quality of life, key components of the general move towards person-centered medicine.