Patient perspectives on alcohol use disorder pharmacotherapy and integration of treatment into primary care settings
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.
Qualitative interviews 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.
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 or had taken medication in the past.
Chart reviews indicated that although 66% of charts documented a discussion of their alcohol use with the provider, only 7.5% of individuals with an AUD diagnosis had a documented discussion of AUD pharmacotherapy, and only 5 received pharmacotherapy.
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 suggest 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.