- Design
- Multicentre cross-sectional study
- Population
- 503 home-care patients (mean age 82) in Japan
- Primary outcome
- Physician-perceived burden on a 0–100 mm visual analogue scale
- Effect
- Excessive polypharmacy +8.20 (95% CI 4.07–12.33); top complexity quartile +7.84 (3.61–12.07)
In seven Japanese home-care services, physicians rated their perceived burden for each of 503 patients, whose mean age was 82 and who took a median of six medicines. Medication regimen complexity was scored with a validated index that counts doses, formulations and special instructions.
After adjustment, excessive polypharmacy and the highest quartile of regimen complexity were each associated with about 8 points more burden on a 100-point scale.
This is cross-sectional and self-reported, and it measures the doctor's experience rather than patient harm. Its use for a family physician is as a prompt: regimen complexity, not just the number of drugs, drives workload for doctors, carers and patients, and simplifying the schedule is a form of deprescribing.
- Count doses and timings, not just drugs, when reviewing a home-bound patient's medicines.
- Consolidate dosing to once or twice daily where equivalent options exist.
- Involve a community pharmacist in reviewing complex regimens for home-care patients.
- Ask carers which part of the regimen is hardest to manage.
Why it matters
Regimen complexity is a hidden workload that simplification can reduce for everyone involved.
Don't overread it
A cross-sectional association with self-rated burden; it does not show effects on patient outcomes.
The statistics, in plain English
A regression coefficient of 8.2 means burden was about 8 points higher on a 0–100 scale for excessive polypharmacy, after accounting for other factors. Whether that difference matters to physicians in practice is not known.
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