The aim of this paper is to one, summarize in a succinct manner the salient points of a recent article from a peer reviewed nursing journal, two, to support and/or refute the authors’ position by integrating ideas and concepts and finally, to critic and describe the relevance of the findings by the authors to clinical practice as well as their impact on the family, community and society.
The article chosen for this assignment is authored by Gadsby,Galloway, Barker, & Sinclair (2011) and is titled “Prescribed medicines for elderly frail people with diabetes resident in nursing homes—issues of polypharmacy and medication costs”. It was first published in the 29th volume of the journal of Diabetes Medicine on pages 136 to139.
“Prescribed medicines for elderly frail people with diabetes resident in nursing homes—issues of polypharmacy and medication costs” was a retrospective study by Gadsby, Galloway, Barker, & Sinclair which was conducted between the months of February and April 2010. It aimed at describing one, the cost and two, the number of drugs prescribed for diabetic patients residing in the nursing homes owned by a primary care unit in the United Kingdom. A retrospective review of the case notes of the 75 diabetic patients residing in the nursing homes owned by the Coventry primary care unit which are 11 in number was done. Of the 75 patients included in the study, 63 (84%) had been put on four or more than four drugs, 59% of the patients were on anti-platelet medications for prophylaxis against diabetes related cardiovascular conditions while 41% had been prescribed for statin medications. The cost of drugs for 18 (24%) of these patients exceeded £101per month. The authors found out that a majority of the latter group of patients had been put on special liquid preparations for the prevention of cardiovascular conditions which occur as a complication of diabetes. The study concluded that the prevalence of polypharmacy amongst diabetic patients residing in nursing homes was high. The authors further concluded that drugs for the prevention of cardiovascular conditions comprised the highest proportion of the medications prescribed for the population of interest, an aspect which they thought was inappropriate due to the limited expected life span for majority of these patients. In addition, the authors concluded that regular review of drugs for diabetic patients in nursing homes was necessary because they associated it with the following benefits, cutting down of costs, reduction of adverse drug-related reactions and maximization of health gains (Gadsby, Galloway, Barker, & Sinclair, 2011, p.136).
The authors of this particular study defined polypharmacy as the concurrent prescription of four medications or more and they based the findings of their study on this blanket definition (Gadsby, Galloway, Barker, & Sinclair, 2011, p.137). However, to fine-tune the findings of their study, they should have classified polypharmacy into one, polypharmacy and two, excessive polypharmacy considering the fact that some researchers define polypharmacy as the concurrent use of nine or more medications (Dwyer, Han, Woodwell, & Reichtsteiner, 2010). As such, their findings would have been more detailed and specific especially considering that based on their results; the patients included in the study had been prescribed for an average of 6.7 oral or parenteral medications.
I however concur with the authors stated position in the introduction that the polypharmacy in the elderly unnecessarily escalates health care costs while increasing the risk for adverse reactions. This is because as stated in the article, medications prescribed for the elderly are normally based on the findings of studies conducted on young persons’ despite the significant differences between the two groups that influence the pharmacodynamics and pharmacokinetics of drugs. Further, I would like to add that accumulating evidence indicates that it’s not only the elderly diabetic population that is being overmedicated but also those with other chronic diseases especially those with co-morbid conditions in several nations across Europe (Onder et al., 2012) and in the United States (Dwyer, Han, Woodwell, & Reichtsteiner, 2010).
On the methods section particularly data collection, I would have in addition to the data collected obtained information relating to the functional status of the patient, sex of the patient, principal payer and length of stay. This is because the aforementioned factors have been shown in other similar studies to increase the probability of polypharmacy (Dwyer, Han, Woodwell, & Reichtsteiner, 2010). Relating to the data analysis, multiple regression analysis especially calculation of odds ratio would have helped to further elucidate on the variables that increased the probability of polypharmacy amongst the population of interest, that is diabetic patients at the Coventry primary care trust nursing homes.
On the discussion, the authors should have compared their findings with those of similar studies conducted elsewhere such as the study conducted on elderly patients with diabetes in France which they had cited in the introduction section. For instance, they should have compared the medications they found over prescribed in their study such as those used for the prevention of cardiovascular disease with those identified by the French study. Comparison of the findings of a study with those of similar studies conducted elsewhere helps to confer external validity on the particular findings.
The authors of this study concluded that polypharmacy in the elderly increased the risk of adverse events as well as the cost of care and in the end, adversely affected the quality of life of these patients whom they described as having a short expected life span (Gadsby, Galloway, Barker, & Sinclair, 2011, p.136). In spite of this, they still advocated for patient autonomy, that is, the right of the patient to make informed decisions relating to their own management (Gadsby, Galloway, Barker, & Sinclair, 2011, p.137). I strongly agree with their position that patients and their relatives when possible should be given the opportunity to decide on whether they would rather be put on more than four concurrent medications or not.
The findings of this study have significant impacts on clinical practice particularly on the care of the family, community and society. Firstly, it identifies cost-cutting measures that can be explored in the care of patients with diabetes in nursing homes such as the withdrawal of the expensive liquid preparations used to prevent cardiovascular disease when they are deemed to be of no clinical benefit. The study also impacts on clinical practice in that it recommends more regular reviews of the medications of diabetic patients in nursing homes. This in turn calls for enhanced cooperation and coordination between the physicians and nurses caring for these patients so that they can identify the indications for when to initiate, change or stop these medications. Finally, as previously mentioned, it highlights the need to facilitate patient autonomy particularly on decisions relating to polypharmacy amongst the elderly, as such, it is necessary for the nurse to educate the patients, families and communities on the risks and benefits of polypharmacy especially on the quality of life. This will enable them to make well informed choices on the modality of management.
In conclusion thus, “Prescribed medicines for elderly frail people with diabetes resident in nursing homes—issues of polypharmacy and medication costs” was a retrospective study by Gadsby, Galloway, Barker, & Sinclair (2011, pp.136-138). It targeted diabetic patients residing in the nursing homes of one of UK’s primary care units. The authors of the study concluded that majority of drugs prescribed for these patients were for the prevention of cardiovascular conditions and that these medications were the most expensive. They further concluded that a regular review of the need for these medications would help to not only lower their costs but also to reduce drug-related adverse events while improving the quality of life. Classification of polypharmacy into polypharmacy and excessive polypharmacy, collection and analysis of data relating to the sex, length of stay amongst other factors and comparison of the findings of the study with those of similar studies in the discussion section are some of the concepts/ideas I would have incorporated into the article. I however concur with the position of the authors on the prevalence and risks of polypharmacy to the elderly and the need for patient autonomy in the management of these patients. The findings of this particular study have considerable significance on clinical practice especially on the care of elderly patients, families, communities and the society at large.
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Carpenter, I., Gindin, J., Finne-Soveri, H., Bernabie, R., & Landi, F. (2012).
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