Creating a multi-level intervention to reduce stigma for buprenorphine use for individuals with End Stage Kidney Disease (ESKD) and Chronic Pain

项目总结/摘要 患有终末期肾病（ESKD）的个体具有高患病率的疼痛状况。共同 由于ESKD本身或透析，止痛药的疗效和安全性较差 治疗丁丙诺啡，一种部分阿片激动剂，作为一种止痛药具有理论优势， 它的代谢是在肝脏中进行的，并且它不被透析。虽然它被批准用于疼痛治疗， 绝大多数被用于治疗阿片类药物使用障碍。对阿片类药物的偏见，尤其是 物质使用障碍的药物可能导致其很少用于疼痛。提供 从完全激动剂阿片类药物转换为丁丙诺啡是治疗中的积极干预手段之一， NIDDK资助的ESKD和慢性疼痛患者的随机对照试验， 血液透析阿片类药物处方努力（HOPE）。这一拟议的补充将加强主要研究 通过审查多层次的障碍，重点是与开始和使用丁丙诺啡有关的耻辱感， ESKD患者因处方长期阿片类药物治疗引起的疼痛和身体依赖性 透析该研究的目标1将为制定多层次的污名干预措施提供信息， 丁丙诺啡止痛药，当有指征时，在ESKD透析患者中，通过 利益相关者访谈患者、肾病学家、透析护士、初级保健医生， 丁丙诺啡处方者、透析组织和保险公司高管。我们会进行 对30名HOPE试验受试者及其家庭成员进行定性访谈（15名接受了 丁丙诺啡和15人没有），以及30名利益相关者，包括透析和初级保健临床医生， 丁丙诺啡处方者、药剂师、透析组织代表和保险公司 高管包括2名患者合作伙伴的研究团队将使用常数分析数据 比较方法为针对个人、组织和结构层面的干预提供信息。 该提案的目标2将采用用户设计冲刺方法来创建一个多功能的蓝图， 一级污名干预，将解决病人（内化污名），临床医生（人际 污名）、透析组织（组织）和保险公司（结构），以解决疼痛障碍 丁丙诺啡治疗ESKD患者，慢性疼痛， 阿片类药物该试验的一个探索性目的将包括一个有效的衡量患者耻辱的方法 参加母公司HOPE试验的患者将在补充剂的时间之后完成。在研究 完成后，研究小组将寻求资金，以测试和传播由此产生的建议， 干预

Project Summary / Abstract Individuals with end stage kidney disease (ESKD) have high prevalence of painful conditions. Common pain medications have poor efficacy and safety profiles due to either the ESKD itself or dialysis treatment. Buprenorphine, a partial opioid agonist has theoretical advantages as a pain medication as its metabolism is in the liver and it is not dialyzed. Although it is approved for pain treatment, it is overwhelmingly prescribed as a treatment for opioid use disorder. Stigma toward opioids and especially medications for substance use disorder may contribute to its being rarely prescribed for pain. Offering to switch from full agonist opioids to buprenorphine is one of the active intervention arms in a HEAL- funded NIDDK-sponsored randomized controlled trial in patients with ESKD and chronic pain, Hemodialysis Opioid Prescription Effort (HOPE). This proposed supplement will augment the main study by examining multilevel barriers, focusing on stigma related to initiation and use of buprenorphine for pain and physical dependence due to prescribed long-term opioid therapy in individuals with ESKD on dialysis. Aim 1 of the study will inform development of a multi-level stigma intervention to facilitate use of buprenorphine pain medication, when indicated, in patients with ESKD on dialysis through stakeholder interviews with patients, nephrologists, dialysis nurses, primary care physicians, buprenorphine prescribers, dialysis organizations and insurance company executives. We will conduct qualitative interviews with 30 HOPE Trial subjects and their family members (15 who accepted buprenorphine and 15 who did not), and 30 stakeholders including dialysis and primary care clinicians, buprenorphine prescribers, pharmacists, dialysis organization representatives and insurance company executives. A study team including 2 patient-partners will analyze the data using the constant comparative method to inform an intervention targeted at personal, organizational and structural levels. Aim 2 of the proposal will employ a user design sprint methodology to create a blueprint for a multi- level stigma intervention that would address patients (internalized stigma), clinicians (interpersonal stigma), dialysis organizations (organizational) and insurers (structural) to address barriers to pain treatment with buprenorphine in individuals with ESKD, chronic pain who are physiologically depending on opioids. An exploratory aim of the trial will include a validated measure of stigma for patients enrolled in the parent HOPE trial to be completed beyond the time of the supplement. At study completion, the research team will seek funding to test and disseminate the resulting proposed intervention.