Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers.
Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers.
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降低 HIV 患者接受阿片类药物治疗慢性疼痛的风险：为 HIV 护理人员开发 TOWER 干预措施。
DOI：
10.1016/j.conctc.2019.100468
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发表时间：
2019
影响因子：
1.5
通讯作者：
中科院分区：
文献类型：
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作者：
Robinson-Papp,Jessica;Aberg,Judith;Benn,EmmaKT;Bryan,Angela;Cedillo,Gabriela;Chikamoto,Yosuke;George,MaryCatherine;Horn,Brady;Kamler,Alexandra;Navis,Allison;Nmashie,Alexandra;Scherer,Maya;Starkweather,Angela;Vickrey,Barbara;
许多艾滋病毒感染者（PWH）经历慢性疼痛，限制了日常功能和生活质量。患有慢性疼痛的PWH通常被处方阿片类药物，有时长达多年，目前还不清楚这些遗留患者的管理是否以及如何根据目前美国阿片类药物的流行而改变。指南，如疾病控制和预防中心慢性疼痛阿片类药物处方指南（CDCG），为此类患者的管理提供了建议，但尚未转化为易于实施的干预措施;也缺乏强有力的证据表明遵守这些建议可以改善患者的结局，如阿片类药物的使用量和疼痛水平。在此，我们描述了一种基于理论的干预措施的开发和初步测试，称为TOWER（TOWard SafEROPIoid Prescribing），旨在支持HIV初级保健提供者在CDCG依从性阿片类药物处方实践中与PWH一起使用阿片类药物治疗慢性疼痛。TOWER将CDCG的内容纳入健康相关行为的信息动机和行为技能（IMB）模型的理论和操作框架。开发过程包括启发式研究和纳入提供者和PWH的反馈;测试正在通过适应性可行性临床试验进行。这一过程的结果将构成一项大型、有效的临床试验的基础，以测试TOWER在促进遵守CDCG的阿片类药物处方实践和改善患有慢性疼痛的PWH的结果方面的有效性。
Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafEROpioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.