Primary care engagement is associated with increased pharmacotherapy prescribing for alcohol use disorder (AUD)

Paul J. Joudrey, Mat Kladney, Chinazo O. Cunningham, Marcus A. Bachhuber

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown. METHODS: We examined a 5-year (2010-2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors. RESULTS: Of 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for patients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care. CONCLUSIONS: The percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume14
Issue number1
DOIs
StatePublished - May 1 2019

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Primary Health Care
Alcohols
Drug Therapy
Prescriptions
Patient Participation
Logistic Models
Demography
Delivery of Health Care

Keywords

  • Alcohol use disorder
  • Engagement
  • Health care services
  • Health care utilization
  • Pharmacoepidemiology
  • Pharmacotherapy
  • Primary care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{bff2d9d436054403b1357b14b7d89091,
title = "Primary care engagement is associated with increased pharmacotherapy prescribing for alcohol use disorder (AUD)",
abstract = "BACKGROUND: Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown. METHODS: We examined a 5-year (2010-2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors. RESULTS: Of 21,159 adults (28.9{\%} female) with AUD, 2.1{\%} (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61{\%} (95{\%} CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56{\%} (95{\%} CI 2.06, 3.06) for patients with limited primary care and 2.89{\%} (95{\%} CI 2.44, 3.34{\%}) for patients engaged with primary care. CONCLUSIONS: The percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.",
keywords = "Alcohol use disorder, Engagement, Health care services, Health care utilization, Pharmacoepidemiology, Pharmacotherapy, Primary care",
author = "Joudrey, {Paul J.} and Mat Kladney and Cunningham, {Chinazo O.} and Bachhuber, {Marcus A.}",
year = "2019",
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doi = "10.1186/s13722-019-0147-3",
language = "English (US)",
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TY - JOUR

T1 - Primary care engagement is associated with increased pharmacotherapy prescribing for alcohol use disorder (AUD)

AU - Joudrey, Paul J.

AU - Kladney, Mat

AU - Cunningham, Chinazo O.

AU - Bachhuber, Marcus A.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND: Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown. METHODS: We examined a 5-year (2010-2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors. RESULTS: Of 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for patients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care. CONCLUSIONS: The percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.

AB - BACKGROUND: Primary care provider skills such as screening, longitudinal monitoring, and medication management are generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary care engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is unknown. METHODS: We examined a 5-year (2010-2014) retrospective cohort of patients with AUD, 18 years and older, at an urban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no primary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy prescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association between primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical factors. RESULTS: Of 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting for confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care was 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for patients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care. CONCLUSIONS: The percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care engagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase primary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing; however, strategies to increase prescribing across health care settings are needed.

KW - Alcohol use disorder

KW - Engagement

KW - Health care services

KW - Health care utilization

KW - Pharmacoepidemiology

KW - Pharmacotherapy

KW - Primary care

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U2 - 10.1186/s13722-019-0147-3

DO - 10.1186/s13722-019-0147-3

M3 - Article

VL - 14

JO - Addiction science & clinical practice

JF - Addiction science & clinical practice

SN - 1940-0632

IS - 1

ER -