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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.
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.