TY - JOUR
T1 - Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management
T2 - A qualitative study
AU - Fernandez, Julianna
AU - Thornton, James Douglas
AU - Rege, Sanika
AU - Lewing, Benjamin
AU - Bapat, Shweta
AU - Xu, Qingqing
AU - Fleming, Marc Labaron
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Objective: To qualitatively assess prescribers' perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings. Design: This was a cross-sectional study. Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016. Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling. Main outcome measures: Prescribers' perceptions regarding hydrocodone rescheduling. Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred. Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians' hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients' satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.
AB - Objective: To qualitatively assess prescribers' perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings. Design: This was a cross-sectional study. Setting: Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016. Participants: Prescribers who manage noncancer pain for geriatric patients were recruited. Focus groups were recorded, transcribed, and then analyzed using ATLAS.ti Qualitative Data Analysis software. Codes were derived from six primary research questions and results were summarized into key themes regarding the impact of rescheduling. Main outcome measures: Prescribers' perceptions regarding hydrocodone rescheduling. Results: Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. They expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions. This led to substituting hydrocodone with potentially less effective pain medications, the inability to issue refills on hydrocodone prescriptions, and an ethical concern over prescribing hydrocodone to patients not under their direct care. Additionally, rescheduling has affected the coordination of care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred. Conclusions: The majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management after discharge. Rescheduling has changed physicians' hydrocodone prescribing patterns, leading to more caution when prescribing hydrocodone and greater use of the PMP. Future studies should assess geriatric patients' satisfaction and quality of life regarding pain management since hydrocodone was rescheduled.
KW - Ethical concerns
KW - Hydrocodone rescheduling
KW - Pain management
KW - Physicians
UR - http://www.scopus.com/inward/record.url?scp=85055693056&partnerID=8YFLogxK
U2 - 10.5055/jom.2018.0464
DO - 10.5055/jom.2018.0464
M3 - Article
C2 - 30387855
AN - SCOPUS:85055693056
SN - 1551-7489
VL - 14
SP - 317
EP - 326
JO - Journal of Opioid Management
JF - Journal of Opioid Management
IS - 5
ER -