Fernandez Julianna, Thornton James Douglas, Rege Sanika, Lewing Benjamin, Bapat Shweta, Xu Qingqing, Fleming Marc L
Clinical Assistant Professor of Pharmacy Practice, Assistant Department Chair, Pharmacy Practice and Translational Research, Clinical Specialist in Geriatrics, Houston Methodist Hospital, Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas.
Assistant Professor of Pharmaceutical Health Outcomes and Policy, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Health Building 2, Houston, Texas.
J Opioid Manag. 2018 Sep/Oct;14(5):317-326. doi: 10.5055/jom.2018.0464.
To qualitatively assess prescribers) perceptions regarding the consequences associated with hydrocodone rescheduling among geriatric patients being discharged from inpatient settings.
This was a cross-sectional study.
Two focus groups were conducted by a trained facilitator in a metropolitan academic medical center in January 2016.
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.
Prescribers) perceptions regarding hydrocodone rescheduling.
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.
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.
定性评估开具处方者对老年患者从住院环境出院后氢可酮重新分类相关后果的看法。
这是一项横断面研究。
2016年1月，在一个大都市学术医疗中心，由一名经过培训的主持人主持了两个焦点小组。
招募了为老年患者管理非癌性疼痛的开具处方者。焦点小组进行了录音、转录，然后使用ATLAS.ti定性数据分析软件进行分析。代码来自六个主要研究问题，结果总结为关于重新分类影响的关键主题。
开具处方者对氢可酮重新分类的看法。
开具处方者提到，重新分类后，他们在开具阿片类药物之前更频繁地查看处方监测计划（PMP）。他们对开具II类处方所需的特殊序列化处方表格表示担忧。这导致用可能效果较差的止痛药替代氢可酮，无法为氢可酮处方开具续方，以及对向非直接护理的患者开具氢可酮存在伦理担忧。此外，重新分类影响了出院时的护理协调，因为转至长期护理机构或专业护理机构的患者在转诊时可能没有足够的疼痛管理。
大多数医生认为重新分类对出院后与疼痛管理相关的患者护理的实际和伦理方面产生了负面影响。重新分类改变了医生的氢可酮处方模式，导致开具氢可酮时更加谨慎，并更多地使用PMP。未来的研究应评估自氢可酮重新分类以来老年患者对疼痛管理的满意度和生活质量。
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