BACKGROUND/RATIONALE:
Alcohol use disorders (AUD) are common and chronic, affecting 6.5% of VA patients. While standard care is to refer patients with AUD to specialty addictions treatment, most do not go. Experts agree that care for AUD should be expanded to primary care settings. While many behavioral treatments that are offered in specialty settings cannot reasonably be delivered in primary care, three medications are FDA-approved for treating AUD, can be prescribed in primary care, and are recommended by VA guidelines. However, most Veterans with AUD (~95%) do not receive them, and there are likely many barriers to primary care providers' prescribing them. This CDA focused on addressing this gap in care for Veterans with AUD.

OBJECTIVE(S):
The specific aims were to: 1) Describe barriers and facilitators to VA primary care providers' treating AUD; 2) Develop and pre-test an intervention to prepare primary care providers to treat AUD in VA primary care; and 3) Test whether the intervention - disseminated in the context of other systems level supports for management of AUD - is effective for increasing prescriptions for AUD medications at a single VA facility.

METHODS:
Planned methods included using 1:1 qualitative interviews (Aims 1 and 2), focus groups (Aim 2), electronic surveys (Aims 2 and 3), and advanced interrupted time series design (Aim 3) applied to secondary VA clinical and administrative data and developing the intervention based on state-of-the-art social marketing methods and other behavior change theories.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Dr. Williams's CDA research resulted in greater understanding of: 1) barriers to provision of pharmacotherapy for AUD in primary care and specialty clinics, 2) disparities in receipt of high-quality care for AUD and HIV across key patient- and community-level characteristics, and 3) patterns of alcohol use and care among transgender Veterans. Further, two implementation interventions are being developed and tested to increase access to care for addictive disorders for key populations of Veterans at risk. This research addresses key HSR&D priority areas (e.g., opioid use), is aligned with the Office of Equity and the Whole Health Initiative, and ultimately holds enormous potential to increase access to and quality of care, as well as health outcomes, for the substantial number of Veterans with substance use disorders.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX001161-01A1
Link: https://reporter.nih.gov/project-details/8596229

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PUBLICATIONS:

None at this time.

DRA: Substance Use Disorders, Health Systems Science
DRE: Technology Development and Assessment, Treatment - Implementation
Keywords: none
MeSH Terms: none