Dr. Jennifer Wisdom, a professor at the CUNY School of Public Health, and colleagues examined the effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders within the U.S. Veterans Health Administration. The work was published in the Journal of Substance Abuse Treatment.
[Photo: Dr. Jennifer Wisdom]
Over 16 million Americans meet diagnostic criteria for alcohol use disorder, but only 7.8 percent of them receive formal treatment each year. Safe and effective pharmacological treatments for alcohol use disorder exist; however, they are rarely prescribed. Therefore, we developed and pilot tested a multifaceted implementation intervention to improve consideration and receipt of effective pharmacologic treatments for alcohol use disorder, focusing on primary care settings where patients have the most frequent contact with healthcare systems.
The intervention included training of local providers to serve as champions and a website for primary care providers that included educational materials, a case-finding dashboard, and contact information for local and national clinical experts. The team also mailed patients educational material about treatment options.
The intervention was implemented at three large facilities of the Veterans Health Administration. An interrupted time series design, analyzed with segmented logistic regression, was used to evaluate the intervention’s effects. The odds of a patient with alcohol use disorder receiving one of the alcohol use disorder medications was increasing throughout the pre-implementation period, and the rate of change increased significantly in the implementation period.
At baseline 2.9 percent of patients filled a prescription for an alcohol use disorder medication within 30 days of a primary care visit. This increased to 3.8 percent by the end of the pre-implementation period (increasing 0.037 percent per month), and increased to 5.2 percent by the end of the implementation period (increasing 0.142 percent per month). However, the intervention effect was not significant when control sites were added, suggesting that improvement may have been driven by secular trends rather than solely by this intervention.
Although the intervention was feasible, it was not effective. The research team continues to analyze the process and implementation data including qualitative interviews with key stakeholders, to elucidate the reasons the intervention was not successful and perhaps find ways to strengthen its effects.