Critical Appraisal of Qualitative Study Evidence Case Study

Clinicians and patients have different views in regard to medication schedules. The difference in perspectives has resulted in substandard compliance with the therapeutic evidence-based directives. When anti-platelets are stopped prematurely, it is likely to cause lethal effects for patients suffering from myocardial infarction, who have been given DES. This article intends to evaluate the similarities between clinicians’ and patients’ supposed reasons for clopidogrel discontinuance by patients (Linda, et al., 2011).

Clinical question

What factors compel patients to withdraw early from the medication?

PICOT of the study

1. Patient Problem: Illness or health status (MI patients).
2. Intervention: Therapies and medications.
3. Comparison: No treatment.
4. Outcome: Fewer symptoms.
5. Time: 3-6 months

Databases used

Used cnu.sagepub.com /content/10/1/50 database to access information of this journal. Ebscohost, Cochran database and google books were also used to get information for the study.

Critical Appraisal of the article

Validity of the study

The study was qualitative and used a descriptive method to gather information for analysis. A total of 22 patients and 22 clinicians from different cities of the U.S. were interviewed. For patients who withdrew medication (clopidogrel) prematurely, the first 11 patients in the register and were prescribed medication at the hospital acquit at one-month proceedings were interviewed. Moreover, 11 patients of analogous demographic background and who continued with medication at one-month proceedings were interviewed.

Data collection was done using semi-structured interviews with clinicians and MI patients. Data analysis was done through the coding of transcriptions where texts and codes were inserted into the electronic program for data analysis (Beck & Polit, 2011). The validity of the study was established to ensure that the obtained data met the methodological rigor benchmarks (Dowling, 2007).

Findings of the study

Sample patients

There was no demographic or clinical characteristics distinction between patients who withdrew clopidogrel and those who continued. Both groups ranged from age 45 to 77 years with the mean age being 53 years old. 55% comprised the continuers while 64% comprised discontinuers. The majority of the patients were Caucasians (82%) for both groups and all patients reported being provided with medication directives at discharge. 82% of the patients had high got education up to high school or more. 73% of patients who continued with prescribed medication had “health insurance cover”.

Sample clinicians

Of all clinicians that were interviewed, 53% of doctors were composed of cardiologists, 33% interior medicine and 13% in the cardiology of intervention. 80% of the physician was male, Caucasian and had an average of 13.8 years experience in the field. 2 nurses who specialized in cardiovascular therapy were also interviewed. Both were women and were Caucasian. They had been in the field for an average of 17 years.

Major topics in the discussion of premature clopidogrel withdrawal include patients’ lack of awareness of diagnostic specifics, poor communication between clinicians and patients, cost of medication and the discrepancy in the shifts of care (clinicians). The findings of the study are credible and have clearly identified human response and encounters. The proposed connection between cost, awareness and communication error and premature withdrawal from medication is consistent with the findings of the study (Larrabee, 2009).

Application of the results to patient care

These findings may also be useful and applicable in patients of HIV/AIDS because, withdrawal from ARVs may be lethal to them. Since I work with HIV/AIDS patients, the findings would be applicable in the situation. These findings may help physicians and clinicians modify their patients’ assessments in order to improve health conditions.

This is possible through improvement of communication between clinicians and patients, reducing medical costs and raising awareness on medication guidelines. The results of the study may be used to educate and counsel patients on the importance of complying with medication directives (Lehane, et al., 2008).

The finding can help understand the social-cultural and ethical factor that influence decision making by patients. This is because the study has pointed out such factors as awareness (social-cultural), cost of medication (social-cultural), communication error (ethical) and discrepancy in the shifts of care (ethical) and shown their connection to withdrawal from medication.

References

Beck, C. & Polit, F. (2011). Nursing Research: Generating and Assessing Evidence for Nursing Practice. New York, USA: Lippincott Williams & Wilkins.

Dowling, M. (2007). From Husserl to Van Manen. A review of different phenomenological approaches, 44(1), 131- 42.

Larrabee, J. (2009). Nurse to nurse: evidence-based practice. New York, USA: McGraw-Hill.

Lehane, E., McCarthy, G., Collender, V., & Deasy, A. (2008). Medication-taking for coronary artery disease: patients’ perspectives. Eur J Cardiovasc Nurs, 7(1), 133 – 9.

Linda, G., et al. (2011). Clinician Patient Discord: Exploring Differences in perspectives for discontinuing Clopidogrel. European Journal of Cardiovascular Nursing, 10(2011), 50 – 55.