Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups: A national study in the U.S. Veterans Health Administration

Williams, Emily C.; Gupta, Shalini; Rubinsky, Anna D.; Glass, Joseph E.; Jones‐Webb, Rhonda; Bensley, Kara M.; Harris, Alex H. S.

doi:10.1016/j.drugalcdep.2017.06.011

Cited by 61 publications

(43 citation statements)

References 46 publications

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“…Findings suggest that receipt of brief intervention was more common among PLWH living in large rural areas than in urban areas, and highlight that PLWH in more rural areas, and particularly those in small rural areas, were potentially underserved regarding receipt of specialty addictions treatment. Consistent with research in non‐HIV‐specific patient populations, AUD medications appeared to be substantially underutilized among all PLWH across rurality. There were no differences in AUD medication use across rural status.…”

Section: Discussionsupporting

confidence: 70%

“…Receipt of specialty addictions treatment (eg, psychosocial interventions in a specialty care setting) was measured based on outpatient clinic stop codes and inpatient bed section codes for any substance use disorder treatment in a specialty care setting with accompanying AUD diagnosis . Receipt of AUD medications was measured based on a filled prescription for acamprosate, disulfiram, topiramate, or oral or injectable naltrexone, similar to previous studies . AUD medications can be prescribed across treatment settings and have demonstrated efficacy for decreasing alcohol use by decreasing cravings, relieving withdrawal symptoms, or intensifying adverse acute reactions to alcohol .…”

Section: Methodsmentioning

confidence: 99%

“…12,33,34 Receipt of AUD medications was measured based on a filled prescription for acamprosate, disulfiram, topiramate, or oral or injectable naltrexone, similar to previous studies. 12,35 AUD medications can be prescribed across treatment settings and have demonstrated efficacy for decreasing alcohol use by decreasing cravings, relieving withdrawal symptoms, or intensifying adverse acute reactions to alcohol. 23 These medications were selected based on having FDA approval for treatment of AUD or strong meta-analytic support for their use in the treatment of AUD, and to be consistent with VA clinical guidelines for substance use disorder treatment at the time of data collection.…”

Section: Receipt Of Alcohol-related Carementioning

confidence: 99%

See 2 more Smart Citations

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

Bensley

Fortney

Chan

et al. 2019

The Journal of Rural Health

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Purpose It is unknown whether receipt of evidence‐based alcohol‐related care varies by rurality among people living with HIV (PLWH) with unhealthy alcohol use—a population for whom such care is particularly important. Methods All positive screens for unhealthy alcohol use (AUDIT‐C ≥ 5) among PLWH were identified using Veterans Health Administration electronic health record data (10/1/09–5/30/13). Three domains of alcohol‐related care were assessed: brief intervention (BI) within 14 days, and specialty addictions treatment or alcohol use disorder (AUD) medications (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 1 year of positive screen. Adjusted Poisson models and recycled predictions were used to estimate predicted prevalence of outcomes across rurality (urban, large rural, small rural), clustered on facility. Secondary analyses assessed outcomes in the subsample with documented AUD. Findings 4,581 positive screens representing 3,458 PLWH (3,112 urban, 130 large rural, and 216 small rural) were included; 49.1% had diagnosed AUD. PLWH in large rural areas had highest receipt of BI (urban 56.6%, 95% CI: 55.0‐58.2; large rural 66.0%, CI: 58.6‐73.5; small rural 60.7%, CI: 54.6‐67.0). PLWH in urban areas had highest receipt of specialty addictions treatment (urban 28.2%, CI: 26.7‐29.8; large rural 19.7%, CI: 13.1‐26.2; small rural 19.6%, CI: 14.1‐25.0). There was no difference in receipt of AUD medications, although overall receipt was low (3%‐4%). Results were similar in the subsample with AUD. Conclusion Among PLWH with unhealthy alcohol use, those in rural areas may be vulnerable to under‐receipt of specialty addictions treatment. Targeted interventions may help ensure PLWH receive recommended care regardless of rurality.

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Section: Discussionsupporting

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Receipt Of Alcohol-related Carementioning

confidence: 99%

See 1 more Smart Citation

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

Bensley

Fortney

Chan

et al. 2019

The Journal of Rural Health

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“…However, despite many physical, psychological, and economic impacts of AUD, the vast majority of persons with AUD do not receive recommended treatments . In one nationally representative sample of US residents, 85% of persons meeting diagnostic criteria for AUD never received treatment for their AUD, and only about 6% of persons with AUD engaged in health care received effective pharmacotherapies …”

mentioning

confidence: 99%

“…2,9 In one nationally representative sample of US residents, 85% of persons meeting diagnostic criteria for AUD never received treatment for their AUD, 9 and only about 6% of persons with AUD engaged in health care received effective pharmacotherapies. [10][11][12] Several barriers to receipt of evidence-based care for AUD have been described. At the patient level, reasons for not seeking help have included not wanting to go to treatment, logistical barriers (including distance and financial barriers), and perceived stigma.…”

mentioning

confidence: 99%

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Young

Achtmeyer

Bensley

et al. 2018

The Journal of Rural Health

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Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

et al. 2020

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BaCKgRoUND aND aIMS:Despite the significant medical and economic consequences of coexisting alcohol use disorder (AUD) in patients with cirrhosis, little is known about AUD treatment patterns and their impact on clinical outcomes in this population. We aimed to characterize the use of and outcomes associated with AUD treatment in patients with cirrhosis. appRoaCH aND ReSUltS: This retrospective cohort study included Veterans with cirrhosis who received Veterans Health Administration care and had an index diagnosis of AUD between 2011 and 2015. We assessed the baseline factors associated with AUD treatment (pharmacotherapy or behavioral therapy) and clinical outcomes for 180 days following the first AUD diagnosis code within the study time frame. Among 93,612 Veterans with cirrhosis, we identified 35,682 with AUD, after excluding 2,671 who had prior diagnoses of AUD and recent treatment. Over 180 days following the index diagnosis of AUD, 5,088 (14%) received AUD treatment, including 4,461 (12%) who received behavioral therapy alone, 159 (0.4%) who received pharmacotherapy alone, and 468 (1%) who received both behavioral therapy and pharmacotherapy. In adjusted analyses, behavioral and/or pharmacotherapy-based AUD treatment was associated with a significant reduction in incident hepatic decompensation (6.5% vs. 11.6%, adjusted odds ratio [AOR], 0.63; 95% confidence interval [CI], 0.52, 0.76), a nonsignificant decrease in short-term all-cause mortality (2.6% vs. 3.9%, AOR, 0.79; 95% CI, 0.57, 1.08), and a significant decrease in long-term all-cause mortality (51% vs. 58%, AOR, 0.87; 95% CI, 0.80, 0.96).CoNClUSIoNS: Most Veterans with cirrhosis and coexisting AUD did not receive behavioral therapy or pharmacotherapy treatment for AUD over a 6-month follow-up. The reductions in hepatic decompensation and mortality suggest that future studies should focus on delivering evidence-based AUD treatments to patients with coexisting AUD and cirrhosis.

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Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups: A national study in the U.S. Veterans Health Administration

Cited by 61 publications

References 46 publications

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

Impact of Alcohol Use Disorder Treatment on Clinical Outcomes Among Patients With Cirrhosis

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