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首页> 外文期刊>Journal of substance abuse treatment >Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration
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Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration

机译：多方面的实施干预措施对美国退伍军人卫生局中酒精使用障碍药理治疗利用的影响

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Abstract Over 16 million Americans meet diagnostic criteria for alcohol use disorder (AUD), but only 7.8% of them receive formal treatment each year. Safe and effective pharmacological treatments for AUD 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 AUD, 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. We also mailed patients educational material about treatment options. The intervention was implemented at three large facilities of the Veterans Health Administration (VHA). An interrupted time series design, analyzed with segmented logistic regression, was used to evaluate the intervention's effects. The odds of a patient with AUD receiving one of the AUD medications was increasing throughout the pre-implementation period, and the rate of change (slope) increased significantly in the implementation period. Translating these numbers into percentages, at baseline 2.9% of patients filled a prescription for an AUD medication within 30days of a primary care visit. This increased to 3.8% by the end of the pre-implementation period (increasing 0.037% per month), and increased to 5.2% by the end of the implementation period (increasing 0.142% 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. Continued analysis of process and implementation data including qualitative interviews with key stakeholders, may elucidate the reasons this intervention was not successful and ways to strengthen its effects. Highlights ? Increasing use of effective medications to treat AUD is a national priority. ? A implementation intervention to increase medication treatment for AUD was tested. ? The intervention was acceptable and feasible, but not superior to national trends.
机译：摘要超过1600万美国人符合酒精使用障碍（AUD）的诊断标准，但其中只有7.8％的每年接受正规待遇。存在安全有效的药理学治疗;但是，它们很少被规定。因此，我们开发和飞行测试了多方面的实施干预，以改善审议和收到有效的AUD药理治疗方法，重点关注患者与医疗系统最常见的接触。干预包括培训本地提供商，作为冠军和初级保健提供者的网站，包括教育材料，案例查找仪表板，以及当地和国家临床专家的联系信息。我们还邮寄了患者教育材料的治疗方案。干预是在退伍军人健康管理局（VHA）的三个大型设施中实施。用分段逻辑回归分析的中断时间序列设计，用于评估干预的效果。在实施前期间，患有AUD接受患者的患者的患者的几率正在增加，实施期限内变化率（坡度）显着增加。将这些数字转化为百分比，在基线2.9％的患者在初级保健访问的30天内填写了AUD药物的处方。在实施前期结束时（每月增加0.037％），这增加到3.8％，并在实施期末增加到5.2％（每月增加0.142％）。然而，当加入控制位点时，干预效果并不重要，这表明改进可能是由世俗趋势而不是通过这种干预而导致的。虽然干预是可行的，但它没有效果。继续分析流程和实施数据，包括与关键利益攸关方的定性访谈，可能阐明这种干预未取得的原因以及加强其影响的方法。强调 ？不断使用有效药物治疗澳元的使用是国家优先事项。还测试了增加澳元药物治疗的实施干预。还干预是可接受的和可行的，但不优于国家趋势。

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