Medications for Alcohol Use Disorder: Unfilled Prescriptions and Treatment Trajectories

治疗酒精使用障碍的药物：未配处方和治疗轨迹

基本信息

批准号：
10598575
负责人：
HAIDEN A. HUSKAMP
金额：
$ 81万
依托单位：
HARVARD MEDICAL SCHOOL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-07-01 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10598575
关键词：
Accidental Injury Acute Address Adherence Admission activity Alcohols Caring Characteristics Chronic Clinical Data Data Set Deductibles Diagnosis Diffuse Disulfiram Drug Prescriptions Education Effectiveness Electronic Health Record Emergency department visit Enzymes Failure Familiarity Fill-It Future Household Income Individual Injury Insurance Insurance Carriers Intervention Interview Laboratory Finding Lead Link Liver Liver Cirrhosis Liver diseases Measures Medical Medicine Mental disorders Methods Morbidity - disease rate Naltrexone Outcome Outpatients Patients Perception Persons Pharmaceutical Preparations Pharmacotherapy Physicians Play Policies Policy Maker Population Practice Management Process Provider Psychiatrist Qualitative Methods Readiness Relapse Reporting Research Role Services Specialist Structure Time Toxicology Visit Woman Writing acamprosate addiction alcohol use disorder clinical training clinically relevant demographics design efficacious treatment evidence base experience falls health plan improved indexing insight male medication compliance men mortality practice setting preference primary care provider provider factors screening, brief intervention, referral, and treatment social stigma therapy design uptake

Accidental Injury Acute Address Adherence Admission activity Alcohols Caring Characteristics Chronic Clinical Data Data Set Deductibles Diagnosis Diffuse Disulfiram Drug Prescriptions Education Effectiveness Electronic Health Record Emergency department visit Enzymes Failure Familiarity Fill-It Future Household Income Individual Injury Insurance Insurance Carriers Intervention Interview Laboratory Finding Lead Link Liver Liver Cirrhosis Liver diseases Measures Medical Medicine Mental disorders Methods Morbidity - disease rate Naltrexone Outcome Outpatients Patients Perception Persons Pharmaceutical Preparations Pharmacotherapy Physicians Play Policies Policy Maker Population Practice Management Process Provider Psychiatrist Qualitative Methods Readiness Relapse Reporting Research Role Services Specialist Structure Time Toxicology Visit Woman Writing acamprosate addiction alcohol use disorder clinical training clinically relevant demographics design efficacious treatment evidence base experience falls health plan improved indexing insight male medication compliance men mortality practice setting preference primary care provider provider factors screening, brief intervention, referral, and treatment social stigma therapy design uptake

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项目摘要

PROJECT SUMMARY: Many individuals with alcohol use disorder (AUD) receive no treatment, including evidence-based pharmacotherapies. Previous research on AUD medication use has primarily relied on claims data, and thus focuses on only a portion of the AUD medication treatment process (i.e., filled prescriptions). Using only claims data, it is not possible to distinguish the characteristics of individuals who do not receive a prescription from a clinician from those who receive one but do not fill it. It is also not possible to understand how medication prescriptions and fills fit into the trajectory of AUD treatment received. To design practice and policy interventions that will improve AUD medication use, clinicians and policy makers need to understand who “falls off” at each point in the treatment process. We propose to use a dataset from a large national insurer with linked claims and electronic health record (EHR) data for the period 2010-2023, as well as interviews of AUD providers, in a mixed methods study. The linked data will allow us to observe written prescriptions for each patient as well as whether or not the prescriptions were filled. The linked data will also allow us to incorporate clinically relevant information available in EHRs but not claims. Using these data, we will: 1) For individuals diagnosed with AUD, identify patient and provider characteristics associated with being prescribed an AUD medication and the time from index AUD encounter to prescription; 2) For individuals diagnosed with AUD who are prescribed an AUD medication, identify patient and prescriber characteristics associated with filling the prescription and with time to prescription fill; and 3) Identify trajectories of AUD care that incorporate information on prescriptions written for individuals diagnosed with AUD, and examine the association between different treatment trajectories and indicators of subsequent relapse and injury. The study's mixed methods approach, including semi-structured interviews of providers who treat AUD about the factors that influence their AUD medication prescribing decisions, will allow a more nuanced examination of AUD medication prescribing than quantitative analyses alone allow. The findings will help pinpoint where in the treatment process different types of people fall out of treatment and how different treatment trajectories are associated with relapse and injury, informing future intervention and policy design.

项目摘要：许多患有饮酒障碍的人（AUD）没有接受治疗，包括基于证据的药物治疗。先前关于使用AUD用药的研究对索赔进行了主要救援数据，因此仅关注AUD用药治疗过程的一部分（即填充处方）。仅使用索赔数据，不可能区分未收到的个人的特征临床医生的处方者的处方，但不填充它。也无法理解药物处方和填充如何适合接受AUD治疗的轨迹。设计实践和临床医生和政策制定者需要了解的政策干预措施将改善AUD用药的使用，谁在治疗过程中的每个点“跌倒”。我们建议使用大型国家的数据集拥有链接索赔和电子健康记录（EHR）数据的保险公司在一项混合方法研究中，AUD提供商的访谈。链接的数据将使我们能够观察书面每个患者的处方以及是否已填充处方。链接的数据也将允许我们合并EHR中可用的临床相关信息，但没有要求。使用这些数据，我们将：1）对于被诊断为AUD的人，确定与存在相关的患者和提供者特征处方了AUD药物以及从索引遭遇到处方的时间； 2）个人被诊断为处方AUD药物的AUD，识别患者和处方药特征与填充处方和处方填充时间有关； 3）确定AUD护理的轨迹结合了有关诊断为AUD的个人的处方信息的信息，并检查不同的治疗轨迹与随后的缓解和伤害的指标之间的关联。这研究的混合方法方法，包括对访问者的半结构化访谈，这些提供者对待AUD 影响其AUD药物处方决策的因素，将允许对与单独定量分析相比，AUD药物处方允许。这些发现将有助于查明治疗过程不同类型的人脱离治疗以及不同的治疗轨迹与救济和伤害有关，告知未来的干预和政策设计。