Factors influencing drug regimen complexity, its impact on geriatric patients’ attitude toward deprescribing, and opportunities for simplification

Background This study aims to identify factors associated with medication regimen complexity (MRC), its impact on patients’ attitude toward deprescribing, and the potential regimen simplifications. Methods A cross-sectional study was conducted among older adults attending outpatient clinics at a teaching hospital in Kuantan, Malaysia. MRC was assessed using the MRC Index (MRCI), while patients’ attitudes toward deprescribing were measured using the revised Patient Attitudes Towards Deprescribing (rPATD) questionnaire. For bivariate analyses, t-test and one-way ANOVA were used for continuous variables. Alternatively, Mann-Whitney U-test, Kruskal-Wallis and Wilcoxon-signed rank were used for nonparametric variables. The Spearman correlation was used to evaluate the correlation of high MRCI with patients’ attitude toward deprescribing. Multivariate analyses were performed to determine predictors of MRC and perceived medication burden which was measured using the burden domain of the rPATD. Results A total of 378 older adult patients participated, with a median MRCI score of 14 (range: 10.0–19.0). Polypharmacy [p < 0.001], Charlson Comorbidity Index (CCI) [p < 0.001], and management of medications [self-managed: p = 0.009, partially self-managed: p = 0.015] significantly predicted high MRCI. The perceived medication burden was significantly associated with monthly income [p = 0.029] and polypharmacy [p < 0.001]. It was found that 52.2% of the patients want to be involved in decision-making about their medications and 94.8% of the patients were willing to stop one or more of their medications. A moderate correlation was observed between MRCI and perceived burden [r = 0.333, p < 0.001]. Theoretical regimen simplification resulted in a statistically significant reduction in median MRCI scores [p < 0.001]. Conclusion Older adults often experience moderate to high regimen complexity, which impacts their perceived medication burden. Future research should focus on implementing practical strategies for regimen simplification in clinical settings.