Perceived barriers to paracetamol (acetaminophen) prescribing, especially following rofecoxib withdrawal from the market

Abstract

Cyclooxygenase-2 inhibitor (COX-2) inhibitors were publicly subsidized in Australia for osteoarthritis. However, guidelines still recommended paracetamol as first choice therapy. When rofecoxib was withdrawn in 2004, paracetamol should have been offered as replacement. However, dispensing data indicate no increase in paracetamol use. The objective of this study was to gain understanding about barriers to paracetamol use and to identify what choices consumers were offered after rofecoxib withdrawal. We conducted two focus groups (consumers and pharmacists) and 15 semi-structured interviews (seven with patients taking rofecoxib at the time it was withdrawn in Australia, four with pharmacists, and four with general practitioners). Familiarity with and use of paracetamol, perceived strengths and weaknesses of paracetamol for chronic pain, and choices given about therapy changes were investigated. All interviews and focus groups were recorded, transcribed verbatim, and thematically analyzed. Consumers reported that transfer of information on their medicines was limited or absent. They perceived that their knowledge about COX-2 inhibitor safety and/or appropriate use of paracetamol was lacking. Pharmacists agreed that several factors were relevant concerning paracetamol and COX-2 inhibitor use, including lack of counseling and information for consumers. Not personalizing prescribing to elderly patients was identified as a weakness. Consumers who had received rofecoxib were divided about their perceptions of the efficacy of paracetamol. It appears that when rofecoxib was withdrawn, they were not offered an opportunity to try paracetamol. Consumers in this study appeared to have poor knowledge about the opportunity to effectively use paracetamol. Consumers did not remember being given the choice to use paracetamol as regular treatment for chronic pain. Pharmacists and doctors did not appear to be discussing options for pain control well with consumers and had mismatched perceptions with consumers about paracetamol. An educational intervention to encourage more rational use of paracetamol is now being planned to provide consumers with more knowledge about paracetamol effective use.