Survey of Physician Knowledge and Counseling Practices Regarding Acetaminophen

Abstract

Objective: To assess physician knowledge regarding acetaminophen dosing, toxicity, and recognition of acetaminophen-containing products and counseling practices when prescribing acetaminophen-containing medications.Methods: Resident and faculty physicians at 1 internal medicine and 2 family medicine residency programs in Alabama were asked to participate in a voluntary survey. Participants completed a 7-item selfadministered questionnaire. Questions were designed to assess physician knowledge of acetaminophen dosing and toxicity, recognition of prescription and over-the-counter products containing acetaminophen, and education provided to patients when prescribing acetaminophencontaining products. Questions were formatted as multiple choice, yes/no, true/false, and short answer. Certain items contained an answer choice of Bunsure.[ Results:Of the 76 physicians who completed the survey, only 76% were aware of the maximum daily dose of acetaminophen. Although 93% recognized Lortab and 90% Percocet as acetaminophen-containing products, only 83% identified Lorcet and 75% Darvocet. More than 90% of physicians correctly identified nonacetaminophen prescription medications with the exception of OxyContin (84%) and Ultram (79%). Knowledge of over-the-counter products was generally less accurate. Ninety-eight percent recognized hepatotoxicity as the primary toxicity. Although 72% of physicians stated they provide specific instructions to patients when prescribing acetaminophen-containing medications, the information provided was limited.Conclusions: Many physicians are unaware of acetaminophen dosing and toxicity issues and have some difficulty identifying acetaminophencontaining products. Information provided by physicians when prescribing acetaminophen products was limited. How this may contribute to unintentional acetaminophen overdose is unclear but should raise concern. These results reinforce the importance of public awareness, patient counseling, and physician education regarding acetaminophen toxicity issues.

Prevalence of exceeding maximum daily dose of paracetamol, and seasonal variations in cold‐flu season

“…In interpreting our reported rates of exceeding the daily 4‐g limit, it is important to note that they are not general‐population rates: as in our previous analyses , but unlike analyses in other studies , the rates are based on individuals who had used paracetamol in the 30 days preceding the study, and who also used it during the week of diary‐keeping. Thus, the present rates are based on a sample of relatively frequent users of paracetamol, and probably over‐estimate the overall population rates of exceeding 4 or 8 g paracetamol in a day.…”

Limited Knowledge of Acetaminophen in Patients with Liver Disease

“…50–56 The variation may be partially explained by different survey formatting 42,43. Our survey only listed options in gram amount and the correct answer (<4 g/day) was the highest of the 5 options provided.…”

Patient Recall of Health Care Provider Counseling for Opioid-Acetaminophen Prescriptions

“…A small number of studies have assessed physician‐counseling practices regarding acetaminophen. One study by Hornsby and colleagues found the majority of physicians (72%) self‐reported providing some counseling when prescribing acetaminophen‐containing medications; however, the information provided to patients was limited [9]. A study by Osborne and Bryant assessed patients' receipt of written emergency department (ED) discharge instructions and found none of the 108 patients receiving opioid‐acetaminophen medications were given written information advising them to discontinue other acetaminophen‐containing medications once they began taking opioid‐acetaminophen medications [10].…”