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Prescribers' perceptions on the impact of hydrocodone rescheduling on geriatric pain management: A qualitative study

Julianna Fernandez, PharmD, BCPS, CGP, James Douglas Thornton, PhD, PharmD, BCPS, Sanika Rege, MS, Benjamin Lewing, MS, Shweta Bapat, BPharm, Qingqing Xu, MS, Marc L. Fleming, PhD, MPH, RPH

Abstract


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.


Keywords


hydrocodone rescheduling, physicians, pain management, ethical concerns

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References


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DOI: http://dx.doi.org/10.5055/jom.2018.0464

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