{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T20:28:09Z","timestamp":1770064089299,"version":"3.49.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T00:00:00Z","timestamp":1594166400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T00:00:00Z","timestamp":1594166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Innovation Funds of The Federal Joint Committee, Germany","award":["01VSF16019"],"award-info":[{"award-number":["01VSF16019"]}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["funding programme Open Access Publishing by the Baden-W\u00fcrttemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universit\u00e4t Heidelberg"],"award-info":[{"award-number":["funding programme Open Access Publishing by the Baden-W\u00fcrttemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universit\u00e4t Heidelberg"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>The increasing complexity of current drug therapies jeopardizes patient adherence. While individual needs to simplify a medication regimen vary from patient to patient, a straightforward approach to integrate the patients\u2019 perspective into decision making for complexity reduction is still lacking. We therefore aimed to develop an electronic, algorithm-based tool that analyses complexity of drug treatment and supports the assessment and consideration of patient preferences and needs regarding the reduction of complexity of drug treatment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Complexity factors were selected based on literature and expert rating and specified for integration in the automated assessment. Subsequently, distinct key questions were phrased and allocated to each complexity factor to guide conversation with the patient and personalize the results of the automated assessment. Furthermore, each complexity factor was complemented with a potential optimisation measure to facilitate drug treatment (e.g. a patient leaflet). Complexity factors, key questions, and optimisation strategies were technically realized as tablet computer-based application, tested, and adapted iteratively until no further technical or content-related errors occurred.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In total, 61 complexity factors referring to the dosage form, the dosage scheme, additional instructions, the patient, the product, and the process were considered relevant for inclusion in the tool; 38 of them allowed for automated detection. In total, 52 complexity factors were complemented with at least one key question for preference assessment and at least one optimisation measure. These measures included 29 recommendations for action for the health care provider (e.g. to suggest a dosage aid), 27 training videos, 44 patient leaflets, and 5 algorithms to select and suggest alternative drugs.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Both the set-up of an algorithm and its technical realisation as computer-based app was successful. The electronic tool covers a wide range of different factors that potentially increase the complexity of drug treatment. For the majority of factors, simple key questions could be phrased to include the patients\u2019 perspective, and, even more important, for each complexity factor, specific measures to mitigate or reduce complexity could be defined.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12911-020-01162-6","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T13:03:51Z","timestamp":1594213431000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Development of an algorithm to detect and reduce complexity of drug treatment and its technical realisation"],"prefix":"10.1186","volume":"20","author":[{"given":"Viktoria S.","family":"Wurmbach","sequence":"first","affiliation":[]},{"given":"Steffen J.","family":"Schmidt","sequence":"additional","affiliation":[]},{"given":"Anette","family":"Lampert","sequence":"additional","affiliation":[]},{"given":"Eduard","family":"Frick","sequence":"additional","affiliation":[]},{"given":"Michael","family":"Metzner","sequence":"additional","affiliation":[]},{"given":"Simone","family":"Bernard","sequence":"additional","affiliation":[]},{"given":"Petra A.","family":"Th\u00fcrmann","sequence":"additional","affiliation":[]},{"given":"Stefan","family":"Wilm","sequence":"additional","affiliation":[]},{"given":"Achim","family":"Mortsiefer","sequence":"additional","affiliation":[]},{"given":"Attila","family":"Altiner","sequence":"additional","affiliation":[]},{"given":"Lisa","family":"Sparenberg","sequence":"additional","affiliation":[]},{"given":"Joachim","family":"Szecsenyi","sequence":"additional","affiliation":[]},{"given":"Frank","family":"Peters-Klimm","sequence":"additional","affiliation":[]},{"given":"Petra","family":"Kaufmann-Kolle","sequence":"additional","affiliation":[]},{"given":"Walter E.","family":"Haefeli","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1215-634X","authenticated-orcid":false,"given":"Hanna M.","family":"Seidling","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"issue":"6","key":"1162_CR1","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s00228-019-02818-7","volume":"76","author":"SJ Schmidt","year":"2020","unstructured":"Schmidt SJ, Wurmbach VS, Lampert A, Bernard S, Consortium H, Haefeli WE, et al. Individual factors increasing complexity in drug treatment \u2013 a narrative review. Eur J Clin Pharmacol. 2020;76(6):745\u201354.","journal-title":"Eur J Clin Pharmacol"},{"issue":"11","key":"1162_CR2","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1007\/s00228-017-2315-2","volume":"73","author":"LL Pantuzza","year":"2017","unstructured":"Pantuzza LL, Ceccato M, Silveira MR, Junqueira LMR, Reis AMM. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol. 2017;73(11):1475\u201389.","journal-title":"Eur J Clin Pharmacol"},{"issue":"6","key":"1162_CR3","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1093\/gerona\/glv219","volume":"71","author":"BC Wimmer","year":"2016","unstructured":"Wimmer BC, Bell JS, Fastbom J, Wiese MD, Johnell K. Medication regimen complexity and number of medications as factors associated with unplanned hospitalizations in older people: a population-based cohort study. J Gerontol A Biol Sci Med Sci. 2016;71(6):831\u20137.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"4","key":"1162_CR4","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1111\/jgs.14682","volume":"65","author":"BC Wimmer","year":"2017","unstructured":"Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, et al. Clinical outcomes associated with medication regimen complexity in older people: a systematic review. J Am Geriatr Soc. 2017;65(4):747\u201353.","journal-title":"J Am Geriatr Soc"},{"issue":"8","key":"1162_CR5","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1517\/14740338.2014.926888","volume":"13","author":"A Lampert","year":"2014","unstructured":"Lampert A, Seiberth J, Haefeli WE, Seidling HM. A systematic review of medication administration errors with transdermal patches. Expert Opin Drug Saf. 2014;13(8):1101\u201314.","journal-title":"Expert Opin Drug Saf"},{"issue":"13","key":"1162_CR6","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1093\/ajhp\/61.13.1380","volume":"61","author":"TJ Moore","year":"2004","unstructured":"Moore TJ, Walsh CS, Cohen MR. Reported medication errors associated with methotrexate. Am J Health Syst Pharm. 2004;61(13):1380\u20134.","journal-title":"Am J Health Syst Pharm"},{"issue":"7","key":"1162_CR7","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1002\/pds.3620","volume":"23","author":"J Freigofas","year":"2014","unstructured":"Freigofas J, Haefeli WE, Schottker B, Brenner H, Quinzler R. Indirect evidence for proton pump inhibitor failure in patients taking them independent of meals. Pharmacoepidemiol Drug Saf. 2014;23(7):768\u201372.","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"4","key":"1162_CR8","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s00228-012-1417-0","volume":"69","author":"JT Schiele","year":"2013","unstructured":"Schiele JT, Quinzler R, Klimm HD, Pruszydlo MG, Haefeli WE. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol. 2013;69(4):937\u201348.","journal-title":"Eur J Clin Pharmacol"},{"issue":"1\u20132","key":"1162_CR9","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.ijpharm.2016.12.004","volume":"517","author":"K Notenboom","year":"2017","unstructured":"Notenboom K, Leufkens HG, Vromans H, Bouvy ML. Learning from patients: identifying design features of medicines that cause medication use problems. Int J Pharm. 2017;517(1\u20132):128\u201334.","journal-title":"Int J Pharm"},{"issue":"1","key":"1162_CR10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1093\/fampra\/cms046","volume":"30","author":"JJ Mira","year":"2013","unstructured":"Mira JJ, Orozco-Beltran D, Perez-Jover V, Martinez-Jimeno L, Gil-Guillen VF, Carratala-Munuera C, et al. Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities. Fam Pract. 2013;30(1):56\u201363.","journal-title":"Fam Pract"},{"issue":"2","key":"1162_CR11","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1046\/j.1525-1497.2001.016002077.x","volume":"16","author":"AJ Muir","year":"2001","unstructured":"Muir AJ, Sanders LL, Wilkinson WE, Schmader K. Reducing medication regimen complexity: a controlled trial. J Gen Intern Med. 2001;16(2):77\u201382.","journal-title":"J Gen Intern Med"},{"issue":"9","key":"1162_CR12","doi-asserted-by":"publisher","first-page":"1369","DOI":"10.1345\/aph.1D479","volume":"38","author":"J George","year":"2004","unstructured":"George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369\u201376.","journal-title":"Ann Pharmacother"},{"issue":"6","key":"1162_CR13","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/j.1365-2710.2012.01356.x","volume":"37","author":"RA Elliott","year":"2012","unstructured":"Elliott RA. Reducing medication regimen complexity for older patients prior to discharge from hospital: feasibility and barriers. J Clin Pharm Ther. 2012;37(6):637\u201342.","journal-title":"J Clin Pharm Ther"},{"issue":"1","key":"1162_CR14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s40264-012-0007-5","volume":"36","author":"D Witticke","year":"2013","unstructured":"Witticke D, Seidling HM, Lohmann K, Send AF, Haefeli WE. Opportunities to reduce medication regimen complexity: a retrospective analysis of patients discharged from a university hospital in Germany. Drug Saf. 2013;36(1):31\u201341.","journal-title":"Drug Saf"},{"issue":"5","key":"1162_CR15","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1093\/jamia\/ocx100","volume":"25","author":"J Varghese","year":"2018","unstructured":"Varghese J, Kleine M, Gessner SI, Sandmann S, Dugas M. Effects of computerized decision support system implementations on patient outcomes in inpatient care: a systematic review. J Am Med Inform Assoc. 2018;25(5):593\u2013602.","journal-title":"J Am Med Inform Assoc"},{"key":"1162_CR16","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/1472-6947-9-30","volume":"9","author":"R Quinzler","year":"2009","unstructured":"Quinzler R, Schmitt SP, Pritsch M, Kaltschmidt J, Haefeli WE. Substantial reduction of inappropriate tablet splitting with computerised decision support: a prospective intervention study assessing potential benefit and harm. BMC Med Inform Decis Mak. 2009;9:30.","journal-title":"BMC Med Inform Decis Mak"},{"issue":"3","key":"1162_CR17","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1136\/amiajnl-2012-001272","volume":"20","author":"MV McDonald","year":"2013","unstructured":"McDonald MV, Peng TR, Sridharan S, Foust JB, Kogan P, Pezzin LE, et al. Automating the medication regimen complexity index. J Am Med Inform Assoc. 2013;20(3):499\u2013505.","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"1162_CR18","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/jep.12383","volume":"22","author":"MV McDonald","year":"2016","unstructured":"McDonald MV, Feldman PH, Barron-Vaya Y, Peng TR, Sridharan S, Pezzin LE. Outcomes of clinical decision support (CDS) and correlates of CDS use for home care patients with high medication regimen complexity: a randomized trial. J Eval Clin Pract. 2016;22(1):10\u20139.","journal-title":"J Eval Clin Pract"},{"issue":"12","key":"1162_CR19","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1111\/j.1745-7599.2008.00360.x","volume":"20","author":"JH Robinson","year":"2008","unstructured":"Robinson JH, Callister LC, Berry JA, Dearing KA. Patient-centered care and adherence: definitions and applications to improve outcomes. J Am Acad Nurse Pract. 2008;20(12):600\u20137.","journal-title":"J Am Acad Nurse Pract"},{"key":"1162_CR20","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12888-015-0605-8","volume":"15","author":"K Aljumah","year":"2015","unstructured":"Aljumah K, Hassali MA. Impact of pharmacist intervention on adherence and measurable patient outcomes among depressed patients: a randomised controlled study. BMC Psychiatry. 2015;15:219.","journal-title":"BMC Psychiatry"},{"issue":"6","key":"1162_CR21","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1164\/rccm.200906-0907OC","volume":"181","author":"SR Wilson","year":"2010","unstructured":"Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181(6):566\u201377.","journal-title":"Am J Respir Crit Care Med"},{"key":"1162_CR22","unstructured":"Kassen\u00e4rztliche Bundesvereinigung: Medikationplan. https:\/\/www.kbv.de\/html\/medikationsplan.php (2019). Accessed 05 June 2020."},{"issue":"2","key":"1162_CR23","first-page":"110","volume":"40","author":"VS Wurmbach","year":"2019","unstructured":"Wurmbach VS, Schmidt SJ, Lampert A, Bernard S, Th\u00fcrmann PA, Haefeli WE, et al. Evaluation eines Konzepts zur Entwicklung von Leitfragen zur Erkennung von Schwierigkeiten bei der Arzneimittelanwendung. Krankenhauspharmazie. 2019;40(2):110.","journal-title":"Krankenhauspharmazie."},{"issue":"5","key":"1162_CR24","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1093\/intqhc\/mzw077","volume":"28","author":"A Lampert","year":"2016","unstructured":"Lampert A, Wien K, Haefeli WE, Seidling HM. Guidance on how to achieve comprehensible patient information leaflets in four steps. Int J Qual Health Care. 2016;28(5):634\u20138.","journal-title":"Int J Qual Health Care"},{"key":"1162_CR25","unstructured":"Deutsche Atemwegsliga e.V. Checklisten f\u00fcr die richtige Inhalationstechnik. http:\/\/www.atemwegsliga.de\/checklisten.html. Accessed 16. July 2019."},{"key":"1162_CR26","volume-title":"Arzneimittel richtig anwenden","author":"WE Haefeli","year":"2013","unstructured":"Haefeli WE, Seidling H, Quinzler R. Arzneimittel richtig anwenden. Stuttgart: Georg Thieme Verlag; 2013."},{"issue":"2","key":"1162_CR27","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s11096-013-9885-6","volume":"36","author":"N Ciociano","year":"2014","unstructured":"Ciociano N, Bagnasco L. Look alike\/sound alike drugs: a literature review on causes and solutions. Int J Clin Pharm. 2014;36(2):233\u201342.","journal-title":"Int J Clin Pharm"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01162-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-020-01162-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-020-01162-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,7]],"date-time":"2021-07-07T23:38:50Z","timestamp":1625701130000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-020-01162-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,8]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1162"],"URL":"https:\/\/doi.org\/10.1186\/s12911-020-01162-6","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,8]]},"assertion":[{"value":"25 July 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The ethical approval was granted by the responsible Ethics Committee of the Medical Faculty of Heidelberg University (S-327\/2017) and the Ethics Committee of the University of Witten\/Herdecke (135\/2017).Written informed consent to participate in the study was obtained from all health care professionals and patients involved in the validation of the key questions. Oral informed consent was obtained from all patients participating in the pilot testing of the key questions in terms of their comprehensibility.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Hanna M. Seidling is a member of the Editorial Board of BMC Medical Informatics and Decision Making. The authors declare that they have no further competing interests with regard to this work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"154"}}