Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness

Abstract

BackgroundActive consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted academic detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites.MethodsAn interrupted time series design, analyzed with mixed-effects segmented logistic regression, was used to evaluate changes in level and rate of change in the monthly percent of patients with a clinically documented AUD who received naltrexone, acamprosate, disulfiram, or topiramate. Using data from a 20 month post-implementation period, intervention sites (n = 37) were compared to their own 16 month pre-implementation performance and separately to the rest of VHA.ResultsFrom immediately pre-intervention to the end of the observation period, the percent of patients in the intervention sites with AUD who received medication increased over 3.4 % in absolute terms and 68 % in relative terms (i.e., 4.9–8.3 %). This change was significant compared to the pre-implementation period in the intervention sites and secular trends in control sites. Sites with lower pre-implementation adoption, more person hours of detailing, but fewer people detailed, had larger immediate increases in medication receipt after implementation. The average number of detailing encounters per person was associated with steeper increases in slope over time.ConclusionsThis study found empirical support for a multifaceted quality improvement strategy aimed at increasing access to and utilization of pharmacotherapy for AUD. Future studies should focus on determining how to enhance the programs effects, especially in non-responsive locations.

Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine

“…19 Other potential strategies to improve uptake and referral to agonist treatment among criminal justice staff could include academic detailing programs—that is, [please provide]—which have been shown to improve the adoption of pharmacotherapy for substance use disorders in other settings. 40 Beyond training and culture change, it is essential that policies be put in place to ensure that justice-involved people have the right and ability to access agonist treatment. A 2015 federal regulation now prohibits drug courts that receive federal funds from denying participants access to or continuity of agonist treatment.…”

Barriers to and facilitators of pharmacotherapy for alcohol use disorder in VA residential treatment programs

“…Academic detailing is a multi-facetted educational outreach program that in which prescribers are presented with information about the targeted medications in a series of face-to-face visits with trained health care professionals. A recent evaluation of this multi-facetted program within VA found a 3.3% positive increase in absolute rates (5.0% to 8.3%) of prescribing of pharmacotherapy for AUD across settings (Harris et al, 2016). …”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…For example, one study found that of the 11 million people in the United States with AUD, only 674,000 received psychopharmacological treatment (Mark et al 2009). Furthermore, treatment availability and the type of treatment provided can vary based on geography and, in the United States, insurance coverage (Hagedorn et al 2016;Mark et al 2015), including formulary restrictions (Harris et al 2013). In a systematic literature review focused on this disparity, Hagedorn et al (2016) identified contributing factors at the level of patients (e.g., lack of awareness of treatment options) and clinicians (e.g., perceived low demand and low confidence in the efficacy of pharmacotherapy).…”

“…Furthermore, treatment availability and the type of treatment provided can vary based on geography and, in the United States, insurance coverage (Hagedorn et al 2016;Mark et al 2015), including formulary restrictions (Harris et al 2013). In a systematic literature review focused on this disparity, Hagedorn et al (2016) identified contributing factors at the level of patients (e.g., lack of awareness of treatment options) and clinicians (e.g., perceived low demand and low confidence in the efficacy of pharmacotherapy). Other clinician barriers to prescribing medications for AUD include an inability to provide suitable psychosocial co-interventions and lack of familiarity with medications (Harris et al 2013;O'Malley and O'Connor 2011).…”

“…The American Society of Addiction Medicine (ASAM) Performance Measures for the Addiction Specialist Physician also include a suggested measure related to receipt of AUD pharmacotherapy (American Society of Addiction Medicine 2014). Changes in prescribing rates could be determined after initiatives to educate clinicians or reduce barriers to pharmacotherapy use (Abraham et al 2011;Harris et al 2016). Electronic decision support could identify individuals with a new diagnosis of moderate to severe AUD (as documented as a problem or diagnosis) and provide information on acamprosate and naltrexone for consideration by the clinician through a passive alert or "infobutton" (Del Fiol et al 2012 …”