Educating Physicians to Reduce Benzodiazepine Use by Elderly Patients by Pimlott, Hux, and Wilson - Assignment Example

? Article Critique: Educating Physicians to Reduce Benzodiazepine Use by Elderly Patients: A Randomized Controlled Trial. Date: Article Critique: Educating Physicians to Reduce Benzodiazepine Use by Elderly Patients: A Randomized Controlled Trial. Research Question Elderly people aged 65 and above are prone to various illnesses and conditions. In order to reduce the pain effects caused by illnesses or old age conditions, medics have come up with various drugs aimed at killing the pains. One of such drugs common among the elderly persons is benzodiazepine. Drugs such as benzodiazepines when taken by elderly persons can be dangerous. However, it is worrying to note that many physicians continue to administer such drugs to elderly persons without interventions. Some of the common side effects associated with the drug include motor vehicle accidents, hip fractures, and cognitive impairments. In order to unravel the mystery surrounding this drug—especially that of prescribing it to elderly persons—a team of researchers, Nicholas J.G. Pimlott, Janet E. Hux, Lynn M. Wilson, Meldon Kahan, Cindy Li, and Walter W. Rosser, carried research on the prescription of benzodiazepine using a randomized controllable trial method. The aim of the research was to educate physicians not to administer benzodiazepine to ailing elderly persons. In order to define the research question addressed by Pimlott and others, the following will be necessary. Participants In defining the research questions related to the participants, the Pimlott et al study identified 1624 primary care physicians who are mostly responsible in attending the elderly people. These physicians had prescribed the benzodiazepine drug more than ten times within a two-month period to sick elderly persons. The researchers wanted to identify how continually the physicians proscribed benzodiazepine drug to their patients. From the confidential reports mailed to the intervention group, it is clear that the primary care physicians continued to prescribe benzodiazepine drug for six months continuous. The researchers were also concerned on the proportion of the benzodiazepine drug administers to the elderly persons, whether they combined it with other psychoactive medications, or whether the physicians performs benzodiazepine therapy. Interventions Although this study applied randomized selection methods, the researchers made some interventions to minimize errors. The number of physicians chosen to participate in the intervention group was 168, while those participating in the control group were 206. One of the intervention measures taken was to ensure that the prescribing characteristics of the two groups were similar (Pimlott et al., 2003, p. 836). Comparison The major comparisons made during the study revolved around the two groups, 168 physicians of the intervention group and 206 physicians of the control group. In the intervention group, the prescriptions of the benzodiazepine drug slightly went down from 20.3 percent to 19.6 percent after the end of the intervention period. On the other hand, the prescriptions of benzodiazepine rose from 19.8 percent to 20.9 percent in the control group. It is imperative to note that these differences were not clinically momentous. Nonetheless, the period of study was the same for prescribed benzodiazepine drugs and that of long-term benzodiazepine therapy. Outcomes Defining research question related to outcomes, the researcher wanted to know the physicians in the two groups, control and intervention, graduated in the same year or are of the same age group. The researchers also wanted to know whether gender was an issue in prescribing drugs. Nevertheless, although there were many more women in the control group as compared to those in the intervention group, the prescribing patterns remained the same. Validity of the study In order to determine the impact of ant research project, validity and reliability of the study is paramount. Validity is either internal or external. While external research mainly deals with the generalization of the results, internal validity revolves around the legitimacy of the study. For instance, in the Pimlott et al study, internal validity revolves around the mean difference between prescriptions of benzodiazepine drugs and control groups. In order to test the validity of the Pimlott et al study, it is imperative consider the following: Random sequence generation The Pimlott et al study applied random sampling in order to ensure validity of the results. Out of the 2800 primary care physicians appearing on the Ontario Benefit database, 2520 of them were randomly selected through the random sequence generation technique. The study selection also took into consideration location of the participants, as choosing more than one participant from the same station would dent the validity of the study results. In order to ensure validity further, those who did not prescribe the drug 10 times within a period of two months were disqualified. Only, 1624 remained, whereby 812 were randomly selected to the intervention group and the rest to the control group. There were further groups of 168 and 206 in the in the intervention and control groups respectively. The fact that the selection was random is a surety that the study was valid (Pimlott et al., 2003, p. 837). Allocation concealment The use of the randomized controlled trial method in this study was meant to avoid foreknowledge, which has a negative influence on the results of the study. The Pimlott et al. study indeed did not involve individuals or hospital staff officers in performing randomization. The date of birth and case record number did not feature in the selection of participants who took part in the study. The study involved centralized randomization in selecting 1624 primary care physicians. Blinding This is one way of establishing the validity of the study. In this method, the participants—physicians—remained blind to the study. This was meant to eliminate any bias in case any party was interested in tampering with the results. Blinding can either be single blind study or double blind study. The Pimlott et al study employed the single blind study. Attrition Attrition is a state where some participants may decide to drop out of the study for various reasons. This is evident in the Pimlott et al study as out of 2800 primary care physicians, only 812 participated. Additionally, only 48% of the respondents returned the questionnaires. Choice of outcome The choice of outcome was equally paramount in the outcome of credible results. The fact that data was collected after every two months for a period of six months was a step towards establishing the effectiveness of the study. Implications, for practice and research, drawn from the study and its findings One of the implications drawn from this study is that there was no relationship between antibiotic prescription and benzodiazepine prescription. In other words, the intervention did not affect benzodiazepine prescribing, due to uniqueness of each physician, the public awareness, and the respondents of the study being the physicians who prescribed the drug most. Other implications drawn from this study include the superior diagnostic uncertainty associated with both benzodiazepine drugs and therapy. In fact, it was also clear that there have been local interventions aimed at changing the manner in which the physicians prescribed the benzodiazepine drugs. Otherwise, in the future, interventions are necessary when administering such drugs (Pimlott et al., 2003, p. 838). References Pimlott, J.G., Hux, J. E., Wilson, L. M., Meldon, K., Cindy, L., & Rosser, W. W., 2003. Educating physicians to reduce benzodiazepine use by elderly patients: a randomized controlled trial. Canadian Medical Association Journal, 168 (7), pp. 836-839. Those for randomized controlled trials Jorund, S., Arne, F., Sture, R., Svein, G., Mette, B., & Ingvild, D., 2006. A cluster- randomized educational intervention to reduce inappropriate prescription patterns for elderly patients in general practice – The Prescription Peer Academic Detailing (Rx-PAD) study. BMC Health Services Research, 6, p. 72. Nicola, M., Giulio, F., Anna, M., Oreste, C., Emilio, M., Claudio., Voci, F., Massimo B., Barbara P.,……. ,Nilla, V., 2007. Randomized controlled trials for evaluating the prescribing impact of information meetings led by pharmacists and of new information formats, in General Practice in Italy. BMC Health Services Research, 7, p. 158.  Read More