Barriers to use of pharmacotherapy for alcohol dependence in VA primary care

退伍军人事务部初级保健中使用药物治疗酒精依赖的障碍

• 批准号: 8543425
• 负责人: Emily Caterina Williams
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8543425
• 关键词: Affect; Alcohol dependence; Alcohols; American Psychiatric Association; Belief; Caring; Chronic; Classification; Clinic; Code; Communication; Consensus; Data; Diagnosis; Disulfiram; Doctor of Philosophy; Electronic Mail; Foundations; Goals; Guidelines; Health; Individual; Interview; Knowledge; Mainstreaming; Medical; Medicine; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Naltrexone; National Committee for Quality Assurance; Nurse Practitioners; Occupations; Outcome; Participant; Patient Care; Patients; Perception; Performance; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Primary Health Care; Provider; Recommendation; Recruitment Activity; Reporting; Research; Research Personnel; Sampling; Site; Social Marketing; Sorting - Cell Movement; Strategic Planning; Structure; Substance Use Disorder; Surveys; System; Transcript; United States Food and Drug Administration; Veterans; Work; abstracting; acamprosate; addiction; alcohol abuse therapy; arm; base; behavior change; care systems; evidence base; handbook; improved; medical specialties; point of care; primary care setting; skills; social stigma; standard care; treatment program

Background: Alcohol dependence is a common, chronic condition affecting 4.2% of VA patients. While specialty addictions treatment programs are effective for treating alcohol dependence, a majority (~66%) of VA patients with alcohol dependence never receive it. Three medications are approved by the Food and Drug Administration (FDA) for alcohol dependence and are considered standard care for alcohol dependence in VA, but ~95% of VA patients with alcohol dependence do not receive them. As such, increasing access to these medications is a major goal of multiple VA stakeholders. While the co-located and team-based care in VA's Primary Care Mental Health Integration Initiative and VA's Patient Aligned Care Teams could enable primary care providers to prescribe and integrate these medications into existing systems of care, there are likely substantial barriers to such integration due to the historic separation of addictions care from mainstream medicine, and alcohol-related stigma. Although previous research in the VA has focused on describing barriers and facilitators to use of medications to treat alcohol dependence among specialty addictions care providers, no previous study has described barriers and facilitators to use of medications to treat alcohol dependence in primary care. An initial step in implementation is to understand primary care providers' perceptions of the feasibility of and barriers to managing alcohol dependence with medications. Objective: The specific aims of the proposed research are to: 1) Describe barriers to and facilitators of primary care providers' use of medications to treat alcohol dependence in VA primary care using qualitative, semi- structured interviews at 9 local primary care clinics, and 2) Develop a survey to assess determinants of use of medications to treat alcohol dependence among a generalizable sample of VA primary care providers. Research Plan: This study will conduct qualitative semi-structured interviews with VA primary care providers at 9 primary care clinics associated with a single local VA medical facility to describe barriers to and facilitators of use of medications to treat alcohol dependence in VA primary care and to develop a subsequent survey. All primary care providers with prescribing privileges who practice at least one half day per week in one of the 9 clinics will be eligible. The recruitment strategy will employ methods previously successfully used by the study team. Providers will be recruited by first establishing communication with a key point-of-contact at each clinic to introduce the study and establish the best method for conducting interviews at the clinic in a way that minimizes the disruption of clinic flow and patient care. Depending on the clinic, interviews will be arranged via email with individual primary care providers or through on-site recruitment. Each potential participant will be asked for referrals to one or more other providers (snowball sampling). An effort will be made to interview providers across job classifications (i.e., staff physicians, resident physicians, and nurse practitioners) and those with potential differing barriers to behavior change regarding treatment of alcohol dependence. Semi- structured interviews will be developed based on a social marketing conceptual framework, which is focused on identifying and removing obstacles to behavior change. All interviews will be digitally recorded and transcribed. Data will be analyzed in an iterative fashion using template analysis (also called thematic coding). The initial template of codes will be based on Robinson's model, but the template will be revised in an iterative fashion. After the template of codes is finalized, two coders will code all interview transcripts. Discrepancies between coders will be reviewed by the study team and resolved with consensus. Content will then be sorted by domain for reporting; key observations in each domain and sub-domain will be abstracted for presentation and used to develop a survey, which will be fielded in a subsequent study.

背景：酒精依赖是一种常见的慢性病，​​影响了4.2％的VA患者。尽管 专业成瘾治疗计划可有效治疗酒精依赖，大多数（约66％）VA 酒精依赖的患者永远不会接受。食品和药物批准了三种药物 用于酒精依赖的给药（FDA）被认为是VA中酒精依赖的标准护理， 但是约有95％的VA酒精依赖患者无法接受。因此，增加对这些的访问 药物是多个VA利益相关者的主要目标。而在弗吉尼亚 初级保健心理健康整合计划和VA的患者对齐护理团队可以启用初级 护理提供者开处方并将这些药物纳入现有护理系统中，可能会有 由于成瘾护理与主流的历史性分离，这种整合的重大障碍 药物和与酒精有关的污名。尽管VA的先前研究重点是描述障碍 和促进者使用药物治疗专业成瘾提供者中的酒精依赖， 以前没有研究描述了使用药物治疗酒精依赖性的障碍和促进因子 初级保健。实施的第一步是了解初级保健提供者对 用药物管理酒精依赖的可行性和障碍。 目的：拟议研究的具体目的是：1）描述主要的障碍和促进者 护理提供者使用药物来治疗VA初级保健中的酒精依赖性 在9个当地初级保健诊所进行结构化访谈，以及2）制定一项调查，以评估使用的决定因素 可以在VA初级保健提供者样本中治疗酒精依赖的药物。 研究计划：本研究将对VA初级保健提供者进行定性半结构化访谈 9与一家本地VA医疗机构相关的初级保健诊所，以描述与 使用药物来治疗VA初级保健中的酒精依赖并进行随后的调查。全部 具有处方特权的初级保健提供者，他们每周至少在9个中练习半天 诊所将符合条件。招聘策略将采用以前成功使用的方法 团队。将首先在每个诊所与关键接触点建立沟通来招募提供商 介绍研究并建立在诊所进行访谈的最佳方法， 最大程度地减少临床流量和患者护理的破坏。根据诊所的不同，面试将通过 通过单个初级保健提供者或通过现场招聘来发送电子邮件。每个潜在参与者将是 要求转介给一个或多个其他提供商（雪球抽样）。将努力面试 跨职位分类的提供者（即员工医师，住院医师和护士从业者）和 那些在酒精依赖治疗方面具有不同障碍的潜在障碍的人。半- 结构化访谈将根据社会营销概念框架开发 识别和消除行为改变的障碍。所有访谈将被数字记录，并且 转录。数据将使用模板分析（也称为主题编码）以迭代方式进行分析。 代码的初始模板将基于Robinson的模型，但该模板将在迭代中进行修订 时尚。最终确定代码模板后，两个编码人员将编码所有面试成绩单。差异 在编码人员之间，研究团队将审查并通过共识解决。然后将内容分类 由域进行报告；每个领域和子域中的关键观察将被抽象为呈现 并用于开发一项调查，该调查将在随后的研究中进行。