Rough Draft Quantitative Research Critique and Ethical Considerations

NRS 433V

Introduction and Background of the Study

Individuals aged 65 years and over exhibit a greater prevalence of the problem of multi-morbidity, or sufferance from multiple chronic health conditions, that require a multiplicity of medications for purposes of managing symptoms and preventing future problems. A combination of these healthcare needs, along with age-connected pharmacokinetic and pharmacodynamic changes often increase the complexity of medical prescription in this special patient population.

Administration of inappropriate prescriptions is a common clinical problem affecting the population of elderly persons in primary nursing care. This reality has been the focus of a significant number of quantitative clinical research studies. Upon recognition of the reality that a limited number of studies have been design to qualitatively explore the phenomenon of potentially inappropriate prescribing, Clyne et al. (2016) conducted a qualitative study to investigate this clinical problem as well as its underlying mechanisms from the viewpoints of general practitioners. Their study aimed at a qualitative exploration of general practitioners’ perspectives concerning prescribing and the problem of inappropriate prescriptions in elderly primary nursing care patients. This was their main research problem and the focus their qualitative study (Clyne et al, 2016).

Having identified the research gap and research problem, the authors established their study’s significance by highlighting the public health concerns associated with inappropriate prescribing in elderly patients. According to Clyne et al (2016), the need to study the phenomenon of potentially inappropriate prescribing arises from the commonly reported consequences of such practice in elderly persons, including a potential for an increase in the prevalence of morbidity, increased hospitalization, and lower health-linked quality of life, as well as a rise in ADEs. According to the study, patients are also likely to face the healthcare risk of polypharmacy. These drugs may also lead to elderly falls that are likely to increase healthcare problems for patients.

There are a number of possible questions explored by the study. What is the prevalence of inappropriate prescribing in elderly persons? What are the clinical ramifications or healthcare consequences of inappropriate prescribing? How best can the problem be reduced? Finally, the paper’s primary focus is: what are the clinician perspectives with respect to the phenomenon of potentially inappropriate prescriptions?

The purpose of Clyne et al (2016) research paper is conduct an exploration of the general practitioners’ perspectives concerning the inappropriate prescription and its impact in elderly primary care patients. There is a substantial connection between the research questions and the purpose of the study as demonstrated in their article.

Method of Study

The authors used semi-structured qualitative interviews as their method in order to investigate the perspectives of general practitioners in a randomized controlled trail design geared toward decreasing the prevalence of potentially inappropriate prescription in elderly patients that would lead to the capstone project’s primary concern of elderly falls and the associated comorbidities. While their focus was on the population of patients in Ireland that were 70 years or older, their application of the quality method was appropriate because the study sought to explore the opinions of general practitioners which, by and large, is a qualitative attribute than can be more effectively explored using the qualitative method.

The authors identified a substantial number of qualitative as well as quantitative studies from literature that were relevant to their study and the focus of the research, and which focused on the clinical issue of inappropriate prescribing and the associated consequences and potential interventions. The literature used is largely based on peer-reviewed journal articles that are accessible in public databases such as PubMed, Google Scholar, and PubMed Central. The articles used in the study are largely current, although the authors have also relied on qualitative articles that date back to 2003, which is still acceptable within the qualitative criterion of article currency. The chosen articles are notably relevant to the topic of research.

Although the authors have used a broad range of relevant peer-reviewed articles, there is limited or no indication or evaluation of the potential weaknesses of the studies used. However, the article’s literature review relied upon adequate data and information on the subject of inappropriate prescribing and its consequences on the elderly population in an effort to build their logical arguments and lay out the results of their findings. Moreover, the authors did not explicitly make develop a particular framework from findings of their study, though their study was based on the OPTI-SCRIPT evaluation process.

Results of Study

Clyne et al. (2016) conducted seventeen semi-structure qualitative interviews involving 13 males and 4 female participants. Results from the findings of their studies identified three primary interrelated themes including complex prescription environment, paternalistic relationships between doctors and patients, and the relevance of potentially inappropriate prescribing as a concept. Patient complexity—including multi-morbidity and polypharmacy, and prescriber complexity—seen in terms of the existence of multiple prescribers, restriction in autonomy, and poor communication were identified in the study as some of the main factors creating complexity in the prescribing setting in which there is a greater chance that potentially inappropriate prescription could possibly take place.

The study is an important contributor to the nursing knowledge with respect to the topic of inappropriate prescription in elderly persons. Its use of qualitative approach was instrumental to nursing literature and body of knowledge in the sense that it enabled the exploration of the complex clinical issues of inappropriate prescribing in elderly primary care in a manner that is unavailable to most quantitative studies. The study has identified a number of interrelated variables that influence the potential occurrence of inappropriate prescribing and older patient medication, which are important to nursing intervention and practice, including the need to improve the management of multi-morbidity and polypharmacy, and to achieve a decrease in potentially inappropriate prescriptions and medications that would lead to such consequences as falling in older persons. The findings of the study are also largely applicable to nursing education in terms of informing the general practitioners and clinicians of the need to understand the concept and processes of potentially inappropriate prescribing.

Ethical Considerations

Clyne et al (2016)’s study received ethical approval to conduct their research from the Irish College of General Practitioners’ Research Ethics Committee. The participants were provided with written information, and consented to participation into the research study. Although there is no reason to doubt it, there little information pointing to the protection of patient privacy.

Conclusion

Potentially inappropriate medication is a common problem in elderly populations, and is linked to a rise in the number of injurious and sometimes fatal falls among this vulnerable patient population in primary care. Clyne et al. (2016) have conducted a clinically relevant qualitative study to identify factors that potentially influence the occurrence of this clinical problem including the prescription environment complexity, and paternalistic relationships between doctors and patients, as well as the little significance that general practitioners have attached to this growing public health concern. Thus, further research is needed to develop interventions that address the noted challenges and improve nursing care for elderly persons.

References

Clyne, B., Cooper, J. A., Hughes, C. M., Fahey, T., & Smith, S. M. (2016). ‘Potentially

inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners

views on prescribing, polypharmacy and potentially inappropriate prescribing in older

people. BMC Family Practice, 17(1), 109