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rofecoxib was withdrawn in 2004,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rofecoxib at the time it was withdrawn in Australia, four with pharmacists, and four with general practitioners).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rofecoxib was withdrawn, they were not offered an opportunity to try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.