Introduction
The administration of high-risk medications among elderly enrollees in the Medicare Advantage Plans has been a matter of great concern since 2005 when the Centers for Medicare and Medicaid Services (CMS) instructed all Medicare Advantage Plans to start reporting their prescription rates of high-risk medications (HRM). The purpose of the study was to determine the predictors of the administration of HRMs’ quality indicators in a national sample of MA enrollees, as defined by the National Committee for Quality Assurance. The null hypothesis of the study was, “Increased burden of chronic diseases and age-related changes in drug metabolism predispose the elderly to adverse drug events precipitated by the use of high-risk medications (HRM)” (Qato & Trivedi, 2012, p. 546).
Problem Statement
The objective of the nursing practice is to ensure that patients receive quality health care, and thus nurses should avoid the administration of medications with adverse effects on patients. The researchers sought to find an alternative solution to High Risk Medications (HRM) for the elderly people. These medications are termed as high risk because they are associated with an increase in morbidity, mortality, hospitalization, in-patient length of stay, and healthcare spending by the elderly people. Hence, the problem of the study is beneficial to nurses as it explores solutions to an issue that has bedeviled their profession for a long time.
In addition, the researchers found a strong correlation between HRM and other factors such as geography, social income, race, and gender. The findings unearthed unethical behaviors in the practice, which implies that the HRM alternatives are made available to some patients based on the aforementioned factors. In addition, the researchers found that HRMs are unsuitable for patients aged 65 and above because they have many associated adverse effects that outweigh their benefits. Hence, there is a great need to adopt the alternative medications and do away with HRMs in order to reclaim the reputation of the nursing profession since nurses are supposed to take care of patients un-discriminatively.
Study Purpose
Researchers had various reasons for their study, which included advocating the adoption of alternatives to HRM, disclosing discrimination in the medical practice, and educating the public on HRMs. HRMs have adverse effects to patients, and thus they should be eliminated in the medical sector in a bid to create room for the adoption of safe alternative methods. According to this study, there is a clear indication of geographical discrimination where the southern regions are affected more by the HRM effects than the northern parts of the United States. Other factors such as socio-economic, race, and gender have reasonable explanations for creating differences in the findings. Alternatives to HRM are expensive, and thus they are not affordable to many people. White people have a record of failing to seek mental health services unlike black people and other races, which make them prone to the adverse effects of HRM. On the other side, females have a high chance of suffering from the adverse effects of HRM due to hormonal imbalances (Qato & Trivedi, 2012). Hence, the purpose of the study was significant to nursing.
Research Question
The main research question was not stated, but it can be said to be “understanding predictors of HRM use at the population level” (Qato & Trivedi, 2012, p. 551). The objective of the research was to find a knowledge gap, which exists in trying to understand the predictors of HRM use in different populations. In their study, the researchers examined the prevalence and predictors of HRMs among a national sample of elderly Medicare Advantage enrollees. From the findings, the researchers observed wide geographic variation in the use of these medications that were not explained by socio-demographic factors. In addition, it was observed that the female gender, the white race, low SES index score, and low personal income also predicted the receipt of HRMs. Hence, the findings answer the aforementioned research question.
Study Variables
There were two main variables with the elderly population making the independent variable and HRM being the dependent variable. According to the researchers, the use of HRM in elderly patients is dependent on various factors, which include the likelihood of patients suffering from adverse effects of HRM such as morbidity and mortality. Hence, their alternatives are considered after they are found dangerous to the patients, thus making them the dependent research variables.
Theoretical Framework
The researchers did not base their work on a theoretical framework. The research was purely experimental, and thus it used retrospective analysis of Healthcare Effectiveness Data and Information Set (HEDIS) data for 6,204,824 enrollees, aged 65 years or older, enrolled in 415 MA plans in 2009. Considering that the objective was to determine the receipt of High Risk Medications amongst the elderly, the researchers used the appropriate framework by making it experimental in order to support the hypothesis by the analysis of the experiment findings. However, the researchers were filling a knowledge gap by creating a theory of predictors of the use HRM in a given population.
Review of Related Literature
The researchers used forty-six published works related to the study. The literature review supported the need for this study as it provided supportive knowledge to the research findings. Normally, researches are experimental and from the findings, some questions about race, social-demographic, gender, and economic reasons came out and their answers were found in other previous works. Literature review helped the researchers to understand that Whites are highly likely to suffer the adverse effects of HRM due to not seeking mental health services, which is common to other races. Females are also highly likely to suffer from the adverse effects of HRM because the drugs are prescribed to treat conditions that are more prevalent in women because due to hormonal defects treated by psychopharmacologic agents such as long-acting benzodiazepines, analgesics, and anticholinergics. Hence, the literature review was relevant to the research. The keywords used include high-risk medications, geriatric prescribing, potentially inappropriate medication, quality prescribing, and disparities.
Methods
Study Design
The research had a descriptive design because the work was done early in the life of the research project through experiments and the rest of the work based on the findings. It was a small-sized study of nine pages, hence not generalizable to large groups of subjects. The reliability of the findings was determined by going back to the subjects with the findings and supporting them through the literature review. The description of the data was detailed and it was filled with stories coupled with information about the feelings and recall of the researchers, thus making them biased of anything that would influence the null hypothesis or the purpose of their study.
Sample and Setting of Data Collection
The research had a very large sample, viz. the entire population of enrollees, which is large enough to produce credible results. The reliability of the research data was determined by the sample size in relation to the size of the population being studied. Hence, taking the entire population as the sample size gave reliable findings. In addition, the data collection was made in the right setting, viz. the Centers for Medicare and Medicaid Services (CMS), where all Medicare Advantage (MA) plans report the prescribing rates of HRM.
Identification and control of extraneous variables
The extraneous variables in the findings included gender, race, social-demographic, and economic factors. These variables would have influenced the research purpose, but researchers acted appropriately to control them by referring to previous studies in the literature review. In addition, the researchers recommended more research to be done on gender and race after establishing that the previous literature on them was less convincing.
Study Instruments/Tools
The researchers used experimental tool, which was adequate for their use in this study. Experimental tools are appropriate where research is descriptive, and thus the emphasis is put on the findings. The data was collected from a reliable source and sample size taken was the entire population, which helped to make the experimental tool adequate for providing reliable finds. Data analysis was used in the research whereby statistical Chi Square was used to prove the validity of the data results, which then proved the validity of the findings.
Strengths and weaknesses
Strengths
Every research study has strengths and limitations. One of the major strengths of this study included the researchers’ use of reliable data. In most cases, it is difficult to find appropriate data to use for developing a research study, hence making it hard for the researchers to have confidence in their work. The data collected from CMS was appropriate for the research as it was the main data collection center. In addition, the use of the entire population as the sample size enabled the research findings to have high confidence levels that proved them valid for research development and this aspect enables the researchers to address the research questions appropriately.
Weaknesses
The research had its limitations, which include overreliance on other researches and literature reviews. The research was short and rich in knowledge, but the extraneous variables were not exploited as required. However, the researchers opted to rely on previous researches and literature reviews by other people, and such sources may not be reliable. Hence, the research left a knowledge gap that could be filled by other researchers in the future. In addition, the researchers focused more on explaining statistical and geographical data, as compared to developing the answer to the research question, which then complicated the research.
Implications of the Study in Nursing
However, the research is applicable to the nursing practice and education, but only for knowledge purposes, as the researchers did not give a strong recommendation on what should be done to eliminate the problem. On the contrary, they gave an insight into what can be done. The research had insignificant implications because it added very little information to the previous knowledge on the issue. In addition, despite the availability of information on how to deal with the issue, practitioners have barely used the data to eliminate the problem. Therefore, another research is needed to offer strong recommendations on what should be done in the future concerning the problem.
Reference
Qato, D., & Trivedi, A. (2012). Receipt of high risk medications among elderly enrollees in Medicare Advantage plans. Journal of General Internal Medicine, 28(4), 546–553.