Determination of a cutoff value for medication regimen complexity index to predict polypharmacy in HIV+ older patient.

espanolIntroduccion. La esperanza de vida de los pacientes VIH+ se ha incrementado. De forma paralela han aumentado las comorbilidades asociadas a la edad y la complejidad farmacoterapeutica. El objetivo del estudio es estimar el valor umbral del indice de complejidad de la farmacoterapia (MRCI) para la determinacion del criterio de polifarmacia en pacientes VIH+ mayores de 50 anos. Metodos. Estudio observacional, trasversal, unicentrico. Se incluyeron todos los pacientes VIH+ mayores de 50 anos, en tratamiento antirretroviral activo entre el 1 enero y 31 diciembre-2015. Se determino la presencia de polifarmacia y los patrones asociados. La complejidad del tratamiento se calculo con la herramienta MRCI (Universidad de Colorado). Se analizo el indice de complejidad total como marcador cuantitativo de polifarmacia mediante la realizacion de una curva ROC y el calculo de su area bajo la curva. Se calculo la sensibilidad y la especificidad de la misma. Resultados. Se incluyeron 223 pacientes. El 56,1% presento polifarmacia, siendo extrema en el 9,4% de los casos. En relacion con el patron de polifarmacia, el 78,0% presentaron un patron cardio-metabolico, el 12,0% psico geriatrico-depresivo, el 8,0% mixto y el 2,0% mecanico tiroideo .Se determino un valor de area bajo la curva ROC de 0,931 con limites entre (0,901-0,962) y p Conclusion. El valor de 11,25 de indice de complejidad es un buen indicador para conocer los pacientes con polifarmacia. El concepto de polifarmacia no solo debe incluir el numero de farmacos que toma el paciente sino incluir tambien la complejidad del tratamiento. EnglishIntroduction. HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities and pharmacotherapeutic complexity. The aim of this study was to determine an optimal cutoff value for Medication regimen complexity index (MRCI) to predict polypharmacy in HIV+ older patients Patients and methods. A transversal observational single cohort study was conducted at a tertiary Hospital in Spain, between January 1st up to December 31st, 2014. Patients included were HIV patients over 50 years of age on active antiretroviral treatment. Prevalence of polypharmacy and it pattern were analyzed. The pharmacotherapy complexity value was calculated through the MRCI. Receiver operating characteristic curve analyses were used to calculate the area under the curve (AUC) for the MRCI value medications to determine the best cutoff value for identifying outcomes including polypharmacy. Sensitivity and specificity were also calculated. Results. A total of 223 patients were included. A 56.1% of patients had polypharmacy, being extreme polypharmacy in 9.4% of cases. Regarding the pattern of polypharmacy, 78.0% had a cardio-metabolic pattern, 12.0% depressivepsychogeriatric, 8.0% mixed and 2.0% mechanical-thyroidal. The ROC curve demonstrated that a value of medication complexity index of 11.25 point was the best cutoff for predict polypharmacy (AUC=0.931; sensitivity= 77.6%; specificity= 91.8%). Conclusions. A cut-off value of 11.25 for MRCI is proposed to determine if a patient reaches the criterion of polypharmacy. In conclusion, the concept of polypharmacy should include not only the number of prescribed drugs but also the complexity of them.