Evaluation of changes in prescription among Japanese elderly patients before and after transition to home care.

Background: Most patients receiving home care have multimorbidity and tend to be prescribed multiple drugs with the complicated regimen. Family physicians (FPs) are responsible for patients' prescriptions after transition to home care. This study aimed to assess changes in medication regimen complexity and potentially inappropriate medications (PIMs) made by FPs before and after transition to home care.

Methods: A retrospective cohort study was conducted in six home care clinics in Ibaraki Prefecture, Japan. Data from patients aged 65 years and older taking any medication who initiated home care between April 2018 and March 2019 were collected using medical records. The medication regimen complexity index-Japanese version (MRCI-J) score and the presence of PIMs were assessed before and 3 months after transition to home care.

Results: The mean age of 169 patients was 84.0 years. MRCI-J score and percentage of PIMs remained unchanged between before and 3 months after home care initiation. However, MRCI-J score significantly decreased among patients with polypharmacy, but significantly increased among patients with nonpolypharmacy. In multiple regression analysis, a greater number of medications before home care initiation was associated with a decreasing MRCI-J score, but pharmacist home visit services were not associated with changes in MRCI-J score.

Conclusions: Our results suggest that FPs involved in home care are trying to adjust prescriptions by simplifying the medication regimen of patients with polypharmacy, and adding symptomatic drugs to those with nonpolypharmacy.