Medication therapy management intervention for the MRCI

The authors of a new study published in the journal Pharmacotherapy validated the Medication Regimen Complexity Index (MRCI) for use in identifying patients who would benefit from medication therapy management intervention. Until now, the MRCI has only been validated at the population and clinical practice levels. Now, the patient-level MRCI can be applied to individual patients using data from claims and electronic medical records databases. The MRCI is a 65-item instrument that assesses the complexity of medication regimens and includes an evaluation of all prescription and over-the-counter medications. For the recent validation study, clinical pharmacists ranked medication regimen complexity and compared these scores to the MRCI and other measures of complexity for two samples that comprised 400 patients: a group of patients with diabetes mellitus and a group of patients with multiple disease states, including diabetes mellitus, hypertension, human immunodeficiency virus infection, and geriatric depression. Overall, the MRCI was better correlated to expert complexity rankings than simple medication count or other patient data. Medication regimen complexity leads to decreased adherence, which, in turn, leads to decreased effectiveness of treatment. Medication regimen complexity increases with pill burden, multiple dosage forms, frequent dosing, and complicated directions for use. With the help of valid instruments such as the MRCI, pharmacists are well positioned to identify and assist patients at risk for decreased adherence and effectiveness owing to complex medication regimens. Pharmacist-directed medication therapy management services have been shown to be beneficial and cost effective across multiple patient populations and among various chronic diseases.


1. Hirsch JD, Metz KR, Hosokawa PW, Libby AM. Validation of a Patient-Level Medication Regimen Complexity Index as a Possible Tool to Identify Patients for Medication Therapy Management Intervention. Pharmacotherapy. Jun 20 2014.
2. Libby AM, Fish DN, Hosokawa PW, et al. Patient-level medication regimen complexity across populations with chronic disease. Clin Ther. Apr 2013;35(4):385-398 e381.
3. Mansur N, Weiss A, Beloosesky Y. Looking beyond polypharmacy: quantification of medication regimen complexity in the elderly. Am J Geriatr Pharmacother. Aug 2012;10(4):223-229.
4. Rettig SM, Wood Y, Hirsch JD. Medication regimen complexity in patients with uncontrolled hypertension and/or diabetes. J Am Pharm Assoc (2003). Jul-Aug 2013;53(4):427-431.

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