QUALITATIVE STUDY REGARDING THE IMPACT OF HYDROCODONE RESCHEDULING ON GERIATRIC PAIN MANAGEMENT: PRESCRIBERS’ PERSPECTIVE

• Main Authors: Fleming, ML, Lewing, B, Bapat, SS, Rege, SA, Xu, Q, Fernandez, J
• Format: Conference Proceeding
• Language: English
• Subjects: Coordination; Data processing; Ethics; Geriatrics; Inpatient care; Long term health care; Nursing; Opioids; Pain; Pain management; Patient satisfaction; Patients; Physicians; Prescribing; Prescription drugs; Qualitative research; Quality of life; Resident physicians; Tramadol
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: To qualitatively assess prescribers' perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings. METHODS: Two focus groups were conducted by a trained facilitator via a semi-structured interview in a metropolitan academic medical center in January 2016. Prescribers who manage pain for geriatric patients were recruited to explore the impact of hydrocodone rescheduling on patient care (e. g., transition of care) following discharge. 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 from the focus groups were summarized into key themes regarding the impact of rescheduling. RESULTS: Emerging themes included both positive and negative views regarding hydrocodone rescheduling. Physicians' expressed concern regarding the required special serialized prescription forms needed to issue schedule II prescriptions in Texas. Issues included substituting hydrocodone with potentially less effective pain medications (e.g., tramadol) and the inability to issue refills on hydrocodone prescriptions. Attending physicians expressed ethical concerns regarding legal questions related to prescribing hydrocodone to patients not under their direct care, since most medical residents and fellows do not have the required serialized prescription forms. Additionally, rescheduling has affected the coordination of pain management care upon discharge, as patients moving to long-term care or skilled nursing facilities may not have adequate pain management when transferred. Prescribers mentioned that they review the prescription monitoring program (PMP) more often before prescribing opioids after rescheduling. CONCLUSIONS: A majority of physicians felt rescheduling negatively impacted both practical and ethical aspects of patient care related to pain management Meanwhile, 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.