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Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings.

Haley SJ, Pinsker EA, Gerould H, Wisdom JP, Hagedorn HJ. Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings. Substance Abuse. 2019 Mar 4; 1-9.

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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.

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