Role of Health Care in Addressing Unhealthy Alcohol Use and Disparities among Aging Women

医疗保健在解决老年妇女不健康饮酒和差异方面的作用

基本信息

批准号：
10705652
负责人：
CYNTHIA I CAMPBELL
金额：
$ 63.37万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-16 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10705652
关键词：
Address Adherence Age Age Years Aging Alcohol abuse Alcohol consumption Alcohols Antidepressive Agents Antihypertensive Agents Anxiety Benzodiazepines Caring Caucasians Clinical Comprehensive Health Care Data Diabetes Mellitus Discipline of obstetrics Disparity Elderly Electronic Health Record Ethnic Origin Ethnic Population Exercise Face Funding Geriatrics Guidelines Gynecology Health Health Personnel Health Services Health Services Accessibility Health behavior Health system Healthcare Healthcare Systems Hypertension Hypoglycemia Individual Interpersonal Violence Intervention Interview Medical Medicine Mental Depression Methods Minority Women Modeling National Institute on Alcohol Abuse and Alcoholism Older Population Opioid Pain Patient Self-Report Patients Pharmaceutical Preparations Primary Care Provider Psychiatric Diagnosis Psychiatry Public Health Race Recommendation Registries Reporting Research Research Priority Risk Risk Factors Role Services System Testing Time Tobacco United States Vulnerable Populations Woman Work addiction adverse outcome age difference age group aging population alcohol effect alcohol intervention alcohol misuse alcohol screening alcohol use disorder baby boomer barrier to care binge drinking brief alcohol intervention brief intervention care systems causal model chronic pain clinical diagnostics clinical risk drinking early alcohol use effective intervention ethnic difference ethnic minority experience follow-up health care delivery health care service utilization health service use high risk holistic approach improved indexing innovation intersectionality medical specialties member men middle age negative affect older women people of color prescription opioid primary care visit racial difference racial disparity racial minority racial population reduced alcohol use screening screening program theories treatment strategy trend

项目摘要

ABSTRACT Unhealthy alcohol use has increased significantly among aging women, raising their risk of serious alcohol related adverse consequences. At the same time, they are less likely than men to access treatment, and this is exacerbated among racial/ethnic minority women. Health care providers and systems will face an increasing number of aging women with alcohol problems, often with co-occurring health conditions that would improve with reduced drinking. Currently, there is limited research on the growing needs of this aging population, including on how racial/ethnic minority women may be disproportionately impacted by unhealthy alcohol use and on how to develop effective interventions. To understand these critical gaps and inform a holistic approach to alcohol-related healthcare, we propose a mixed-method study of over one million (1,298,009) aging women (≥age 50) in a diverse health care delivery system of over 4.5 million members. We leverage unique longitudinal electronic health record (EHR) data from a universal alcohol screening program in primary care, with an estimated 784,794 aging women regularly screened for unhealthy alcohol use at multiple primary care visits between 2014-2022. We integrate screening data with a NIAAA-funded alcohol registry that contains medical and psychiatric diagnoses, self-report health behaviors (e.g. tobacco, exercise, interpersonal violence screening), and health service encounters across clinical settings. Our approach is guided by a conceptual model that incorporates Intersectionality Theory and the Andersen’s Model of Health Services Utilization. We first identify trends and predictors of unhealthy alcohol use (defined as exceeding guidelines or alcohol use disorder) among aging women overall and by age and race/ethnicity. Second, we test whether health services utilization (e.g., routine primary care visits, brief alcohol interventions, medications, and addiction and/or psychiatry treatment) is associated with reductions in alcohol use over time among all aging women who report unhealthy alcohol use and among subsets with co-occurring health conditions (e.g., chronic pain, depression/anxiety, diabetes and hypertension) and medication use (e.g., opioids). Across each aim, we examine racial/ethnic differences to identify potential disparities. We use advanced causal modeling approaches to analyze hypothesized relationships, and to appropriately control for potential confounding and biases. For a deeper understanding of these vulnerable patients’ needs and potential barriers to care, we conduct qualitative interviews with aging women who report unhealthy alcohol use and with providers who care for them in different medical settings (e.g. primary care, geriatrics, addiction medicine), which we triangulate with the quantitative data. Findings will provide urgently needed evidence on how health services can impact unhealthy alcohol use, so that health care systems can better identify and treat this vulnerable population through targeted interventions.

抽象的老年妇女的不健康饮酒量显着增加，增加了严重酒精的风险相关的不利后果。同时，他们比男人不太可能获得治疗，这就是在种族/族裔少数族裔妇女中加剧。医疗保健提供者和系统将面临越来越多的患有酒精问题的衰老妇女的数量通常会有同时发生的健康状况减少饮酒。目前，关于这个老龄化人口不断增长的需求的研究有限，包括不健康的饮酒，包括种族/少数民族妇女如何受到不成比例的影响以及如何制定有效的干预措施。了解这些关键差距并为整体方法提供信息对于与酒精有关的医疗保健，我们提出了一项超过一百万（1,298,009）老年妇女的混合方法研究（≥50）在潜水员的医疗保健提供系统中，成员超过450万。我们利用独特的来自初级保健的通用酒精筛查计划的纵向电子健康记录（EHR）数据，估计有784,794名老年妇女定期筛查多个初级保健的不健康饮酒 2014 - 2022年之间的访问。我们将筛选数据与NIAAA资助的酒精注册中心集成了医学和精神诊断，自我报告健康行为（例如烟草，运动，人际暴力筛查），卫生服务在临床环境中遇到。我们的方法以概念为指导结合了交叉性理论和安德森（Andersen）的卫生服务使用模型的模型。我们首先确定使用不健康饮酒的趋势和预测因素（定义为超出指南或饮酒疾病）在整体上衰老的妇女，年龄和种族/种族。第二，我们测试健康服务是否利用（例如，常规初级保健访问，简短的酒精干预，药物和成瘾和/或精神病学治疗）与所有报告的老年妇女中随着时间的推移饮酒的减少有关不健康的酒精使用以及具有同时发生健康状况的子集（例如，慢性疼痛，抑郁/焦虑，糖尿病和高血压）和药物使用（例如阿片类药物）。在每个目标中，我们检查种族/种族差异以识别潜在分布。我们使用高级因果建模分析假设关系的方法，并适当控制潜在的混杂和偏见。为了深入了解这些脆弱患者的需求和潜在的护理障碍，我们与报告不健康饮酒的老年妇女以及关心的提供者进行定性访谈在不同的医疗环境（例如初级保健，老年医学，成瘾医学）中，我们进行了三角测量使用定量数据。调查结果将提供急需的证据，证明卫生服务如何影响不健康的饮酒，以便医疗保健系统可以更好地识别和治疗这一脆弱人群通过有针对性的干预措施。