Patient recall of health care provider counseling for opioid-acetaminophen prescriptions

Objective: The aim of this study was to determine the frequency and nature of physician, nurse, and pharmacist verbal counseling at the time of a new prescription for an opioid-acetaminophen containing medication as recalled by patients. Design: A mixed methods approach with data from cross sectional, structured interviews was used. Setting: The settings were one academic emergency department in Chicago, IL and one outpatient pharmacy at a public hospital in Atlanta, GA. Patients: One hundred forty-nine patients receiving a new prescription for an opioid-acetaminophen medication were enrolled. Methods: Interviews assessed patient recall of counseling they received from their physician, nurse, and pharmacist upon receiving the new prescription. Their responses were unitized and assigned to categories. Results: One hundred forty-nine patients were enrolled; 61.1% African American and 58.4% female. Seven major categories of responses were noted; frequencies of patient recall for counseling in these categories were reported. Four categories related to the content of the counseling discussion were 1) details of administration (patient recall counseling from: physician/nurse only 44.3%, pharmacist only 5.4%, both providers 12.8%); 2) activities to avoid and side effects (36.2%, 4.7%, 8.7%); 3) medication indication (32.9%, 4%, 4%); and 4) addictive potential (9.3%, 1.3%, 0%). Three categories describe patients' recall of the interaction in broad terms: 5) being referred to print informational material accompanying the prescription (MD/RN only 7.4%, pharmacist only 20.1%, both providers 2.7%); 6) having questions solicited (0%, 11.4%, 0%); 7) having no interaction relating to medication counseling (3.4%, 32.2%, 1.3%). Conclusions: Patients infrequently recall counseling from providers on topics that are important to prevent harm from opioid-acetaminophen prescriptions. Future patient-centered clinical research should target identifying optimal strategies to convey these critical messages.