Institute for Behavioral Research, University of Georgia, Athens, 30602-2401, USA.
J Stud Alcohol Drugs. 2011 Jul;72(4):669-77. doi: 10.15288/jsad.2011.72.669.
The objectives of this study were to (a) identify the patterns of disulfiram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfiram and tablet naltrexone; and (c) measure reasons for medication discontinuation.
Two waves of data were collected via face-to-face structured interviews with 223 program administrators.
These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfiram/tablet naltrexone with a newer AUD medication.
These findings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specific training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use.
本研究的目的是：(a) 在一个全国性的私人资助提供物质使用障碍治疗的项目样本中，确定在 48 个月的时间内使用戒酒硫（安塔布司）和纳曲酮片（利维亚）的模式；(b) 检验可持续性、后期采用、停用和不采用戒酒硫和纳曲酮片的预测因素；以及 (c) 衡量停药的原因。
通过与 223 名项目管理员进行面对面的结构化访谈收集了两个阶段的数据。
这些数据表明，酒精使用障碍（AUD）药物的采用是一个动态的过程。尽管不采用是最常见的模式，但在研究期间，约有 20%的项目持续使用 AUD 药物，30%的项目在采用方面经历了组织变革。双变量多项逻辑回归模型显示，组织特征与可持续性相关，包括医院环境中的位置、项目规模、认证、私人保险收入、来自刑事司法系统的转介、医疗人员数量以及基线时使用选择性 5-羟色胺再摄取抑制剂。发现了两种停药模式：项目要么停止使用所有物质使用障碍药物，要么用新的 AUD 药物替代戒酒硫/纳曲酮片。
这些发现表明，AUD 药物的采用可能会受到认证机构的压力、与初级保健医生合作、为医疗人员提供特定于药物的培训、增加资源的可用性以支付与开处方 AUD 药物相关的费用、以及修改刑事司法合同以包括对 AUD 药物使用的支持等因素的积极影响。
