Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
Department of Health Services, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2018 Mar;33(3):258-267. doi: 10.1007/s11606-017-4202-z. Epub 2017 Oct 30.
Three medications are FDA-approved and recommended for treating alcohol use disorders (AUD) but they are not offered to most patients with AUD. Primary care (PC) may be an optimal setting in which to offer and prescribe AUD medications, but multiple barriers are likely.
This qualitative study used social marketing theory, a behavior change approach that employs business marketing techniques including "segmenting the market," to describe (1) barriers and facilitators to prescribing AUD medications in PC, and (2) beliefs of PC providers after they were segmented into groups more and less willing to prescribe AUD medications.
Qualitative, interview-based study.
Twenty-four providers from five VA PC clinics.
Providers completed in-person semi-structured interviews, which were recorded, transcribed, and analyzed using social marketing theory and thematic analysis. Providers were divided into two groups based on consensus review.
Barriers included lack of knowledge and experience, beliefs that medications cannot replace specialty addiction treatment, and alcohol-related stigma. Facilitators included training, support for prescribing, and behavioral staff to support follow-up. Providers more willing to prescribe viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective "tool" or "foot in the door" for treating AUD, and believed that providing AUD medications in PC might catalyze change while reducing stigma and addressing other barriers to specialty treatment. Those less willing believed that medications could not effectively treat AUD, and that treating AUD was the role of specialty addiction treatment providers, not PC providers, and would require time and expertise they do not have.
We identified barriers to and facilitators of prescribing AUD medications in PC, which, if addressed and/or capitalized on, may increase provision of AUD medications. Providers more willing to prescribe may be the optimal target of a customized implementation intervention to promote changes in prescribing.
三种药物获得了 FDA 的批准并被推荐用于治疗酒精使用障碍（AUD），但大多数 AUD 患者并未使用这些药物。初级保健（PC）可能是提供和开具 AUD 药物的最佳场所，但可能存在多种障碍。
本定性研究使用社会营销理论，一种采用商业营销技术的行为改变方法，包括“细分市场”，来描述（1）PC 中开具 AUD 药物的障碍和促进因素，以及（2）将 PC 提供者分为更愿意和不太愿意开具 AUD 药物的组别后，他们的信念。
定性、基于访谈的研究。
来自五家 VA PC 诊所的 24 名提供者。
提供者完成了面对面的半结构化访谈，这些访谈被记录、转录，并使用社会营销理论和主题分析进行分析。提供者根据共识审查被分为两组。
障碍包括缺乏知识和经验、认为药物不能替代专业成瘾治疗以及与酒精相关的污名。促进因素包括培训、对开具处方的支持以及行为工作人员以支持后续跟进。更愿意开具处方的提供者将 AUD 的处方视为其作为 PC 提供者角色的一部分，将药物视为治疗 AUD 的潜在有效“工具”或“敲门砖”，并认为在 PC 中提供 AUD 药物可能会促进变革，同时减少污名化并解决专业治疗的其他障碍。不太愿意的提供者则认为药物不能有效治疗 AUD，治疗 AUD 是专业成瘾治疗提供者的角色，而不是 PC 提供者的角色，而且需要他们不具备的时间和专业知识。
我们确定了 PC 中开具 AUD 药物的障碍和促进因素，如果加以解决和/或利用，可能会增加 AUD 药物的提供。更愿意开具处方的提供者可能是定制实施干预措施的最佳目标，以促进开具处方的改变。
