Primary care engagement is associated with increased pharmacotherapy prescribing for alcohol use disorder (AUD)

Paul J Joudrey,Marcus A Bachhuber,Mat Kladney,Chinazo O Cunningham

doi:10.1186/s13722-019-0147-3

Abstract

BackgroundPrimary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown.MethodsWe examined a 5-year (2010–2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors.ResultsOf 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for patients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care.ConclusionsThe percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.

Highlights

Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy
During the 2 years after AUD diagnosis, 57.1% of AUD patients had no primary care, 16.9% had limited primary care, and 26.0% were engaged with primary care
The probability of patients with limited primary care receiving an AUD pharmacotherapy prescription was 2.56% and 2.89% for patients engaged with primary care (Table 2)

Summary

Introduction

Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. In the United States, 68.5 million adults develop an AUD during their lifetime [1] and 88,000 alcohol-related deaths occur annually [2]. Primary care settings provide an opportunity for AUD treatment because of primary care providers’ ability to diagnose AUD both through screening and through detecting medical conditions or symptoms caused or exacerbated by alcohol use [11, 12]. Primary care provider skills, such as longitudinal monitoring and medication management, and organizational strategies can improve chronic disease outcomes and are readily generalized to AUD pharmacotherapy [13, 14]

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Results

Discussion

Conclusion