Saturday, February 20, 2016

When HIV Treatment Goals Conflict with Guideline-Based Opioid Prescribing: A Qualitative Study of HIV Providers

HIV-infected patients have high prevalence of chronic pain and opioid use, making HIV care a critical setting for improving the safety of opioid prescribing. Little is known about HIV treatment providers' perspectives about opioid prescribing to patients with chronic pain.

We administered a questionnaire and conducted semi-structured telephone interviews with 18 HIV treatment providers (infectious disease specialists, general internists, family medicine physicians, nurse practitioners, and physician assistants) in Bronx, NY. Open-ended interview questions focused on providers' experiences, beliefs, and attitudes about opioid prescribing and about use of guideline-based opioid prescribing practices (conservative prescribing, and monitoring for and responding to misuse). Transcripts were thematically analyzed using a modified grounded theory approach.

Eighteen HIV treatment providers included 13 physicians, 4 nurse practitioners, and 3 physician assistants. They were 62% female, 56% white, and practiced as HIV providers for a mean of 14.6 years. Most reported always or almost always using opioid treatment agreements (56%) and urine drug testing (61%) with their patients on long-term opioid therapy. HIV treatment providers tended to view opioid prescribing for chronic pain within the "HIV paradigm," a set of priorities and principles defined by three key themes: 1) primacy of HIV goals, 2) familiarity with substance use, and 3) the clinician as ally. The HIV paradigm sometimes supported, and sometimes conflicted with guideline-based opioid prescribing practices. For HIV treatment providers, perceived alignment with the HIV paradigm determined whether and how guideline-based opioid prescribing practices were adopted. For example, the primacy of HIV goals superseded conservative opioid prescribing when providers prescribed opioids with the goal of retaining patients in HIV care.

Our findings highlight unique factors in HIV care that influence adoption of guideline-based opioid prescribing practices. These factors should be considered in future research and initiatives to address opioid prescribing in HIV care.

Purchase full article at:

  • 1 Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
  • 2 Center for Alcohol Studies, Rutgers University , New York , NY , USA.
  • 3 University of Alabama at Birmingham , Birmingham , AL , USA. 
  •  2016 Feb 9:0. 

No comments:

Post a Comment