title: Physicians' intention to prescribe hydrocodone combination products after rescheduling: A theory of reasoned action approach.
abstract: The U.S. Drug Enforcement Administration (DEA) rescheduled hydrocodone combination products (HCPs) in an attempt to mitigate the prescription opioid epidemic. Many in the medical and pharmacy community expressed concerns of unintended consequences as a result of rescheduling.
  
  
  
  This study examined physicians' intentions to prescribe HCPs after rescheduling using the framework of the theory of reasoned action (TRA).
  
  
  
  A cover letter containing a link to the online questionnaire was sent to physicians of the Texas Medical Association who were likely to prescribe opioids. The questionnaire assessed physicians' intentions to prescribe HCPs after rescheduling. Predictor variables included attitude toward rescheduling, subjective norm toward HCP prescribing, and past prescribing behavior of schedule II prescriptions. All variables were measured on a 7-point, Likert-type scale. Intention to prescribe as a dependent variable was regressed over TRA variables and respondent characteristics.
  
  
  
  A total of 1176 usable responses were obtained, yielding a response rate of 13.3%. Mean (M) age was 53.07 ± 11 and most respondents were male (70%) and Caucasian (75%). Physicians held a moderately positive intention to prescribe HCPs (M = 4.36 ± 2.08), held a moderately negative attitude towards rescheduling, M = 4.68 ± 1.51 (reverse coded). Subjective norm was moderately low, M = 3.06 ± 1.78, and past prescribing behavior M = 2.43 ± 1.21. The linear regression analysis indicated that attitude (β = 0.10; P = 0.006), subjective norm (β = 0.35; P < 0.0001) and past prescribing behavior (β = 0.59; P < 0.0001) were significant predictors of intention to prescribe HCPs after rescheduling.
  
  
  
  TRA was shown to be a predictive model of physicians' intentions to prescribe HCPs after rescheduling. Overall, physicians held a moderately positive intention to prescribe HCPs. Past behavior concerning schedule II prescribing was found to be the most significant predictor of intention. Understanding the impact of federal rule changes on pain management care and patient satisfaction is necessary to determine whether this change has produced the intended consequences without harming patients in need of HCPs.
authors: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA. Electronic address: mlflemi2@central.uh.edu.
authors: Marc L
authors: ML
authors: Fleming
authors: Department of Pain Medicine, Division of Anesthesiology and Critical Care, The University of Texas-MD Anderson Cancer Center, Houston, TX 77030, USA.
authors: Larry
authors: L
authors: Driver
authors: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
authors: Sujit S
authors: SS
authors: Sansgiry
authors: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
authors: Susan M
authors: SM
authors: Abughosh
authors: Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
authors: Matthew
authors: M
authors: Wanat
authors: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
authors: Ruta V
authors: RV
authors: Sawant
authors: Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Texas Medical Center Campus, 1441 Moursund St, Houston, TX 77030, USA.
authors: Erin
authors: E
authors: Ferries
authors: School of Nursing, University of Houston, 14000 University Blvd., Sugar Land, TX 77479, USA.
authors: Kathleen
authors: K
authors: Reeve
authors: The University of Texas-MD Anderson Cancer Center, Unit 1468, 1515 Holcombe Blvd., Houston, TX 77030, USA.
authors: Knox H
authors: KH
authors: Todd
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000145:classification; D001291:Attitude of Health Personnel; D061891:Controlled Substances / Q000008:administration & dosage* / Q000145:classification; D003430:Cross-Sectional Studies; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage* / Q000145:classification; D033182:Intention; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011582:Psychological Theory; D011795:Surveys and Questionnaires; D013781:Texas; D014481:United States; D037041:United States Government Agencies
chemical_list: D000701:Analgesics, Opioid; D061891:Controlled Substances; D006853:Hydrocodone
keywords: Hydrocodone; Opioid prescribing; Pain management; Prescription drug abuse; Rescheduling; Theory of reasoned action