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

Abstract

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.

Keywords:

• Alcohol use disorder
• pharmacotherapy
• treatment

Additional information

Funding

The project was supported by the Veterans Health Administration’s Office of Research and Development’s Health Services Research and Development’s Quality Enhancement Research Initiative’s Service Directed Project no. 11-411. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

Notes on contributors

Sean J. Haley

Drs. Haley, Wisdom, and Hagedorn conceptualized the article. Drs. Haley and Wisdom contributed to qualitative analyses, Drs. Pinsker and Hagedorn contributed to quantitative analysis, and all authors contributed to data interpretation. Dr. Haley took lead on writing the initial draft, and all authors assisted with revisions.

Erika A. Pinsker

Drs. Haley, Wisdom, and Hagedorn conceptualized the article. Drs. Haley and Wisdom contributed to qualitative analyses, Drs. Pinsker and Hagedorn contributed to quantitative analysis, and all authors contributed to data interpretation. Dr. Haley took lead on writing the initial draft, and all authors assisted with revisions.

Heather Gerould

Drs. Haley, Wisdom, and Hagedorn conceptualized the article. Drs. Haley and Wisdom contributed to qualitative analyses, Drs. Pinsker and Hagedorn contributed to quantitative analysis, and all authors contributed to data interpretation. Dr. Haley took lead on writing the initial draft, and all authors assisted with revisions.

Jennifer P. Wisdom

Drs. Haley, Wisdom, and Hagedorn conceptualized the article. Drs. Haley and Wisdom contributed to qualitative analyses, Drs. Pinsker and Hagedorn contributed to quantitative analysis, and all authors contributed to data interpretation. Dr. Haley took lead on writing the initial draft, and all authors assisted with revisions.

Hildi J. Hagedorn

Drs. Haley, Wisdom, and Hagedorn conceptualized the article. Drs. Haley and Wisdom contributed to qualitative analyses, Drs. Pinsker and Hagedorn contributed to quantitative analysis, and all authors contributed to data interpretation. Dr. Haley took lead on writing the initial draft, and all authors assisted with revisions.