Patient Perspectives on Alcohol use Disorder Pharmacotherapy and Integration of Treatment into Primary Care Settings

Abstract

Background Evidence-based pharmacotherapies for alcohol use disorders (AUDs) are underutilized. This mixed-methods study reports supplementary findings from the alcohol use disorder pharmacotherapy and treatment in primary care (ADaPT-PC) implementation study at 3 Veterans Health Administration (VHA) hospital sites to understand why prescription rates did not increase following the ADaPT-PC intervention. Methods Qualitative interviews ( N = 30) were conducted in advance of the ADaPT-PC intervention to understand patients’ pharmacotherapy attitudes among those in AUD treatment, with previous treatment experience, or who needed assistance with their alcohol use. Following the ADaPT-PC intervention, chart reviews from a random sample of patients with AUD or a most recent Alcohol Use Disorders Identification Test consumption questions (AUDIT-C) score >8, and no active AUD prescription, were conducted to determine the frequency of alcohol-related conversations ( N = 455). Results Most interviewed patients welcomed a discussion about their alcohol use and pharmacotherapy. Of the 15 medication-naïve patients interviewed, 6 stated that they would be willing to try pharmacotherapy, 5 stated that they were unlikely, 2 identified reservations, 1 said no, and 1 was not asked. Fifteen patients were either currently taking medications ( n = 10) or had taken medication in the past ( n = 7; 2 patients had past and current experience). Chart reviews indicated that although 66% of charts ( n = 299) documented a discussion of their alcohol use with the provider, only 7.5% ( n = 22) of individuals with an AUD diagnosis had a documented discussion of AUD pharmacotherapy, and only 5 received pharmacotherapy. Conclusion Most interviewed patients were open to discussing AUD treatment, including discussions of pharmacotherapy, with their provider. From documented conversations about alcohol use to treatment options, medical records suggests a continuous narrowing of the number of patients engaged in alcohol-related consultations. Although some interviewed patients expressed reticence about initiating pharmacotherapy, these findings suggest that the treatment cascade may have a greater influence on the number of pharmacotherapy prescriptions than patients’ preferences.

Using practice facilitation to improve alcohol-related care in primary care: a mixed-methods pilot study protocol

“…A major strength of this project is the collection and assessment of perspectives from key stakeholders (clinical and Veteran) on comprehensive alcohol care (i.e., screening, BI, prescribing AUD medications, referral/warm-hand-off to specialty treatment) to inform and hone a practice facilitation intervention aimed at improving care while meeting their goals and needs. Moreover, this project extends previous qualitative work with Veterans [ 67 , 68 ] by assessing demographically diverse Veterans on their perceptions of barriers and facilitators of comprehensive alcohol-related care in PC settings, which both builds on prior work while offering new contribution. In addition, we believe Aim 2 focus groups are a strength, as they offer efficiency of gathering many opinions, stimulate discussion that may not naturally occur in one-on-one interviews, and may also provide opportunities to identify views that fall outside “the norm” or outliers, which can skew findings if not identified [ 69 ].…”

The correlates and extent of prescribing of medications for alcohol relapse prevention in England

“…Willingness to take medications, perceptions of the addiction potential of medications and awareness of medications for ARP were identified as barriers. More recently, Haley et al [33] conducted interviews with service users with an alcohol use disorder to establish attitudes to medications for ARP. Concerns regarding the medication's effectiveness and potential drug interactions and side effects were found to be potential barriers to being prescribed medications for ARP.…”

“I Felt I Was Reaching a Point with My Health”: Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care

“…The ReDUCE program offered a variety of elements integrated into the PCP (daily drinking tracking surveys, therapy, medication) and patients seemed to weigh the importance of each of these depending on their individual needs, goals, and current drinking pattern. Related specifically to AUD medication, previous research suggests that patients generally appreciate having the option to discuss medication with PCPs, 52 but that they may need multiple therapy sessions prior to initiating. 9 This was reflected by some patients in this study who said they would not have participated if medication was the only option or that they were considering medications only after receiving therapy.…”