Introduction
This article, entitled Inappropriate Medication Administration to the Acutely Ill Elderly: A Nationwide Emergency Department Study, 1992-2000 by Jeffrey M. Caterino, Jennifer A. Emond, and Carlos A. Camargo published in the Journal of American Geriatric Society on 11/19/2004 intends to determine the rate of inappropriate administration of drugs to the elderly in emergency departments. Its secondary objective is to determine the risk of being administered inappropriate medication.
The main aim of the study
The study also attempts to say whether such administration could be justified by the diagnosis in some cases. This observational study is not directed particularly at investigating the adverse side effects of drugs, as it only analyzes the structure of their administration in certain patient categories, therefore the problem of causality is not that relevant to this study.
This study performs a retrospective analysis of visits to emergency departments and identifies inappropriate medications with the help of Beers’ 1997 explicit criteria. Because the problem of causality is irrelevant to this article, it does not interfere with the usage of the cross-sectional design, which is usually inappropriate when investigating pharmaceutical treatments (Beaglehole, Bonita, Kjellstrom, 1993).
However, some approaches to the performed data analysis call for questioning. Thus, during the evaluation of the inappropriate drug administration risk, this risk appeared to be the highest for the patients, who have been administered several medications. But, it should be considered that this conclusion is quite evident, even without calculating the risk, and does not make any sense.
Another aspect of the data analysis that should be discussed is that based on it there was a conclusion made about the fraction constancy of inappropriate administrations during different years, however, the conditions of gathering these data were unequal. For example, in the beginning, only three medications were recorded, and later on – five.
In this article, it has been pointed out that frequently there was an absence of diagnosis that would correspond to one or another inappropriate administration however the number of diagnoses included in the system was limited to three, hence some of those diagnoses could not be included in the system.
Critique
Concerning the conclusions, implications, and recommendations, there was no analysis of the inappropriate administration fraction depending on separate institutions. The above could be done very easily. In this case, the recommendations could be more specific.
Regarding the general considerations, the basis for stratification of the administrations and the following conclusions appeared to be the thesis concerning the existence of some “inappropriate” for individuals over 65 medications, formulated in the Beers’ criteria (1997). It would be wise to remark that these criteria, and correspondingly the list of medications have not been investigated in randomized blindfold studies, and they appear to be the opinion of the experts. Therefore their level of evidence according to the principles of evidence-based medicine is regarded as the most inferior – C.
References
- Beaglehole, R., Bonita, R., Kjellstrom, T. (1993). Basic Epidemiology. Geneva: WHO p.54-55
- Jenicek, M. (2002). Foundations of Evidence-Based Medicine. New York: Parthenon Publishing.