Reducing Medication Regimen Complexity
A Controlled Trial
Andrew J. Muir, MD, Linda L. Sanders, MS, William E. Wilkinson, PhD, Kenneth Schmader, MD
OBJECTIVE: To determine if a visual intervention (medication
grid) delivered to physicians can reduce medication regimen
DESIGN: Nonrandomized, controlled trial.
SETTING: Veterans Affairs medical center.
PATIENTS/PARTICIPANTS: Eight hundred thirty-six patients
taking at least 5 medications at the time of admission and the
48 teams of physicians and students on the general medicine
INTERVENTION: For intervention patients, a medication grid
was created that displayed all of the patients' medicines and
the times of administration for 1 week. This grid was delivered
to the admitting resident soon after admission.
MEASUREMENTS AND MAIN RESULTS: For the patients of each
team of physicians, we calculated the change in the average
number of medications and doses from admission to discharge.
The number of medications in the intervention group
decreased by 0.92 per patient, and increased by 1.65 in the
control group (P < .001). The mean number of doses per day in
the intervention group decreased by 2.47 per patient and
increased by 3.83 in the control group (P < .001).
CONCLUSIONS: This simple intervention had a significant
impact on medication regimen complexity in this population.
Apparently, physicians were able to address polypharmacy
when the issue was brought to their attention.
KEY WORDS: polypharmacy; drug therapy; medical
J GEN INTERN MED 2001;16:77±82.
hysicians today provide care to patients with multiple
medical problems at a time when the development and
use of medications is increasing. These trends, combined
with recommendations from clinical practice guidelines
and consumer demand for drugs, often result in complex
medication regimens for many patients. The complexity of
a medication regimen can be defined by the number of
medications (polypharmacy) and the number of times per
day or ``doses'' that the patient takes a medication (multi-
ple dosing schedules). Complex medication regimens are
troublesome to patients and physicians due to the resulting
problems of nonadherence, therapeutic failure, and
adverse drug reactions.
In addition, complex medica-
tion regimens contribute to the estimated costs of $20 to
$70 billion dollars per year due to drug-related morbidity
Previous interventions directed at physicians to impact
polypharmacy have met with variable success. While chart
review followed by detailed recommendations from physi-
cians have decreased medications,
attempts with ge-
riatric consultation teams, clinical pharmacists, and
monthly computerized summaries generally have not
reduced numbers of medications.
Even when success-
ful, the time and expense required by these interventions
would make implementation impractical. In addition, these
studies have focused on the number of medications only,
largely ignoring dosing schedule, which is a critical factor
determining regimen complexity.
To address the problem of medication regimen com-
plexity, we designed a simple visual tool in the form of a
7-day medication grid depicting the number of medications
and doses each patient was supposed to take during each
week. The grid was designed to quickly illustrate regimen
complexity to physicians and encourage them to simplify
the regimen. The objective of the study was to determine if
the medication grid significantly reduced the number of
medications and doses prescribed by physicians in an
intervention group compared with the control group.
Study Design and Setting
The study was a controlled trial of the medication grid
versus no intervention among resident physicians and
inpatients with polypharmacy (operationally defined as
taking at least 5 medications concurrently) who were the
patients of resident physicians. The site for the study was
Received from the Division of Gastroenterology (AJM), Depart-
ment of Medicine (LLS), Division of Biometry, Department of
Community and Family Medicine (WEW); and Division of
Geriatrics, Department of Medicine and the Center for the Study
of Aging and Human Development (KS), Duke University Medical
Center; and Geriatric Research, Education and Clinical Center,
Durham Veterans Affairs Medical Center (KS); Durham, NC.
Address correspondence and reprint requests to Dr. Muir:
DUMC Box 3913, Durham, NC 27710 (e-mail: muir0002@mc.