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.
Highlights
Active 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
Among the Veterans Health Administration (VHA) patients diagnosed with AUD in FY13, only 5.8 % received evidenced-based pharmacotherapy
The pre-to-post increase in slope in the intervention sites compared to the pre-implementation slope was significantly positive (p < .0001), with the proportion of patients with AUD receiving medication increasing to 8.32 % by the end of Month 36
Summary
Active 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 Both psychosocial and pharmacological treatments for alcohol use disorder (AUD; formerly abuse and Harris et al Addict Sci Clin Pract (2016) 11:15 specialty addiction programs, the treatment rate among the roughly 400,000 patients clinically diagnosed with an AUD in fiscal year 2013 (6.8 % of all VA patients) was only 32 %. Several medications are US Federal Drug Administration (FDA)-approved for the treatment of AUD, and/or have support of effectiveness from high-quality metaanalysis, namely naltrexone, acamprosate, disulfiram, and topiramate These medications can be prescribed and managed in diverse clinical settings [1,2,3], allowing patients more options regarding the type and location of their AUD treatment, potentially increasing access and treatment engagement. Even among Veterans seeking treatment in one of VHA’s specialty addiction treatment programs, only 9.9 % received medication treatment for AUD [9, 15]
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