PMID- 37855117 OWN - NLM STAT- MEDLINE DCOM- 20231102 LR - 20240208 IS - 1753-4666 (Electronic) IS - 1753-4658 (Print) IS - 1753-4658 (Linking) VI - 17 DP - 2023 Jan-Dec TI - Associations of medication regimen complexity with medication adherence and clinical outcomes in patients with chronic obstructive pulmonary disease: a prospective study. PG - 17534666231206249 LID - 10.1177/17534666231206249 [doi] LID - 17534666231206249 AB - BACKGROUND: High medication burdens are common in patients with chronic obstructive pulmonary disease (COPD). This study aimed to explore the associations of medication regimen complexity index (MRCI) with medication adherence and clinical outcomes among patients with acute exacerbations of COPD (AECOPD) after hospital discharge. METHODS: Data were obtained from a nationwide cohort study of inpatients with AECOPD in China. MRCI scores were calculated using the medication list 30 days after discharge and separated into COPD-specific and non-COPD MRCI scores. Medication adherence was measured by the withdrawal rate of COPD or inhaled long-acting bronchodilators 6 months after discharge. Clinical outcomes included re-exacerbations and COPD-related readmissions during the 30-day to 6-month follow-up period. The associations of MRCI with medication withdrawal and clinical outcomes were evaluated using univariate and multivariate logistic regressions. Potential covariates included sociodemographic factors, year of COPD diagnosis, post-bronchodilator percentage predicted forced expiratory volume in 1 s, mMRC score, CAT score, and comorbidities. RESULTS: Among the 2853 patients included, the median total MRCI score was 7 [interquartile range (IQR), 7-13]. A high MRCI score (>7) was presented in 1316 patients (46.1%). Of the MRCI score, 91% were COPD specific. The withdrawal rates of the COPD and inhaled long-acting bronchodilators were 24.2% and 24.4%, respectively. Re-exacerbation and COPD-related readmission rates were 10.2% and 7.5%, respectively. After adjusting for covariates, patients with high total MRCI scores were less likely to discontinue COPD drugs [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.52-0.74] and inhaled long-acting bronchodilators (OR, 0.68; 95%CI, 0.57-0.81); conversely, these patients were more likely to experience re-exacerbation (OR, 1.64; 95% CI, 1.27-2.11) and readmission (OR, 1.57; 95% CI, 1.17-2.10). CONCLUSION: MRCI scores were relatively low among post-hospitalized patients with AECOPD in China. Higher MRCI scores were positively associated with adherence to COPD or inhaled medications, and risk of re-exacerbation and readmission. REGISTRATION: ClinicalTrials.gov identifier: NCT02657525. FAU - He, Ruoxi AU - He R AUID- ORCID: 0000-0001-9598-218X AD - School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. AD - Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Hunan, China. FAU - Wang, Ye AU - Wang Y AD - School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Ren, Xiaoxia AU - Ren X AD - Department of Pulmonary and Critical Care Medicine, National Centre for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Huang, Ke AU - Huang K AD - Department of Pulmonary and Critical Care Medicine, National Centre for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Lei, Jieping AU - Lei J AD - Department of Clinical Research and Data Management, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Niu, Hongtao AU - Niu H AD - Department of Pulmonary and Critical Care Medicine, National Centre for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Li, Wei AU - Li W AD - Department of Pulmonary and Critical Care Medicine, National Centre for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Dong, Fen AU - Dong F AD - Department of Clinical Research and Data Management, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Li, Baicun AU - Li B AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. AD - National Center for Respiratory Medicine Laboratories, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China. FAU - Yang, Ting AU - Yang T AD - Department of Pulmonary and Critical Care Medicine, National Centre for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Centre for Respiratory Diseases, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing 100029, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. FAU - Wang, Chen AU - Wang C AUID- ORCID: 0000-0001-7857-5435 AD - School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, No.9 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China. AD - National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China. AD - Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. LA - eng SI - ClinicalTrials.gov/NCT02657525 PT - Journal Article PL - England TA - Ther Adv Respir Dis JT - Therapeutic advances in respiratory disease JID - 101316317 RN - 0 (Bronchodilator Agents) SB - IM MH - Humans MH - *Bronchodilator Agents/adverse effects MH - Prospective Studies MH - Cohort Studies MH - *Pulmonary Disease, Chronic Obstructive/diagnosis/drug therapy MH - Medication Adherence PMC - PMC10588411 OTO - NOTNLM OT - adherence OT - chronic obstructive pulmonary disease OT - exacerbation OT - medication regimen complexity OT - pharmacotherapy OT - readmission COIS- The authors declare that there is no conflict of interest. EDAT- 2023/10/19 06:46 MHDA- 2023/10/19 06:47 PMCR- 2023/10/19 CRDT- 2023/10/19 05:33 PHST- 2023/10/19 06:47 [medline] PHST- 2023/10/19 06:46 [pubmed] PHST- 2023/10/19 05:33 [entrez] PHST- 2023/10/19 00:00 [pmc-release] AID - 10.1177_17534666231206249 [pii] AID - 10.1177/17534666231206249 [doi] PST - ppublish SO - Ther Adv Respir Dis. 2023 Jan-Dec;17:17534666231206249. doi: 10.1177/17534666231206249.