Dr. Jennifer Wisdom, a professor at the CUNY Graduate School of Public Health and Health Policy (CUNY SPH), and colleagues examined the effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders (AUD) within the U.S. Veterans Health Administration (VA). The work was published in the Journal of Substance Abuse Treatment.
Over 16 million Americans meet diagnostic criteria for AUD, but only 7.8% of them receive formal treatment each year. Safe and effective pharmacological treatments for alcohol use disorder exist; however, they are rarely prescribed. Dr. Wisdom and colleagues 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 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 effects of the intervention. The odds of a patient with AUD receiving one of the AUD medications increased throughout the pre-implementation period, and the rate of change increased significantly in the implementation period.
At baseline, 2.9% of patients filled a prescription for an AUD medication within 30 days 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 trends unrelated to this intervention.
Although the intervention was feasible, it was not effective. “This is a beautiful example of a health services research study: when you have an effective intervention but health structure may not be set up to provide it effectively and there may be barriers to providers prescribing it,” explains Dr. Wisdom. “An organizational intervention (champions to assist providers, provider education, and patient information) did not increase prescribing of medication assisted therapies for alcohol abuse in this situation more than controls, possibly due to secular trends with the VA increasing prescribing system wide.”
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.
Harris, A., Brown, R., Dawes, M., Dieperink, E., Myrick, D., Gerould, H., Wagner, T., Wisdom, J. and Hagedorn, H. (2017). Effects of a multifaceted implementation intervention to increase utilization of pharmacological treatments for alcohol use disorders in the US Veterans Health Administration. Journal of Substance Abuse Treatment, 82, pp.107-112.