Identifying Barriers and Facilitators to Pain Management With Buprenorphine for Patients With Kidney Failure: A Thematic Analysis of Interviews With Key Partners.

Rationale & Objective: Treating pain with analgesic medications in patients with kidney failure receiving dialysis is often complicated owing to altered pharmacokinetics, affecting efficacy and safety of medications. Buprenorphine, a partial opioid agonist without these limitations, has potential value in pain treatment in kidney failure. The aim of this qualitative study was to identify barriers and facilitators to overcoming stigma for implementation of buprenorphine as a pain treatment in patients treated with dialysis. Study Design: Thematic analysis of interview data. Setting & Participants: We used snowball sampling to enroll physicians with expertise in pain management and kidney failure, and other key partners. Exposures: Participants completed semistructured interviews. Topics covered included facilitators and barriers to pain management and buprenorphine prescription for patients with kidney failure. Outcomes: Qualitative themes. Analytical Approach: Interviews were transcribed and coded using the MAXQDA software (VERBI Software). We performed a thematic analysis to determine the most salient themes. Results: Of the 26 participants, 17 were physicians with expertise in nephrology, addiction psychiatry, palliative care, internal medicine, and physical medicine and rehabilitation. The other 9 participants included representatives from payors, retail pharmacy, and dialysis organizations. We identified the following 5 themes: (1) lack of knowledge about buprenorphine, (2) pervasiveness of pain- and buprenorphine-related stigma, (3) perception of pain management as beyond nephrologists' scope of practice, (4) sociostructural barriers to pain management, and (5) suggestions to overcome the barriers. Limitations: Our sample had limited racial and ethnic diversity and may not represent the perspectives of key partners working within different health systems or geographic locations. Conclusions: Significant barriers to effective pain management and access to buprenorphine exist for patients with kidney failure at multiple levels (ie, patient, provider, organization, and systems levels). Therefore, multilevel interventions that include components that target patient stigma, clinician education, and increase collaboration among key partners are needed.