酒精性肝硬化患者对酒精使用障碍治疗的误解、偏好和障碍。
Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis.
机构信息
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, Ann Arbor, MI, United States; VA Center for Clinical Management Research, Ann Arbor, MI, United States; Transplantation Institute, Loma Linda University Health, Loma Linda, CA, United States.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, Ann Arbor, MI, United States; VA Center for Clinical Management Research, Ann Arbor, MI, United States; Transplantation Institute, Loma Linda University Health, Loma Linda, CA, United States.
出版信息
J Subst Abuse Treat. 2018 Aug;91:20-27. doi: 10.1016/j.jsat.2018.05.003. Epub 2018 May 18.
BACKGROUND
While alcohol cessation improves mortality in alcoholic liver disease (ALD), many patients struggle to achieve abstinence. Our aim was to characterize ALD patients' preferences, misconceptions, and barriers to alcohol use treatment options.
METHODS
This mixed-methods study included outpatients with a history of alcohol-related cirrhosis or alcoholic hepatitis recruited from a hepatology clinic for a survey or an in-depth semi-structured interview. We purposefully sampled men and women, compensated and decompensated patients to ensure adequate representation of gender and severity of liver disease for the qualitative interviews.
RESULTS
123 patients completed surveys among which 50% reported having at least one drink within the past year while only 20 patients were in any form of current alcohol treatment. Of the 23 patients reporting drinking within 3 months, only 3 were in AUD treatment currently. 17% had at least one misconception about alcohol use or treatment. An additional 22 ALD patients (10 women, 12 men) completed phone interviews of which two-third self-reported alcohol abstinence. All 22 interview participants had awareness of some form of alcohol treatment, but 13 felt that they did not need treatment with several characterizing it as ineffective or a "waste of time." Misconceptions included inaccurate perceptions of relapse medication side effects, beliefs that the presence of advanced liver disease symptoms means it is too late to treat alcohol use, and a lack of understanding about the chronicity of alcohol use disorders. The most common barriers to treatment included unwillingness to be in treatment, financial/insurance and transportation barriers.
CONCLUSIONS
Alcohol use treatment was underutilized in many ALD patients, despite active drinking in many. Tailored education and preference sensitive treatment engagement may overcome barriers to alcohol use treatment and promote abstinence.
背景
尽管戒酒可以改善酒精性肝病 (ALD) 患者的死亡率，但许多患者难以戒酒。我们旨在描述 ALD 患者对酒精使用治疗选择的偏好、误解和障碍。
方法
本混合方法研究纳入了从肝病诊所招募的有酒精相关肝硬化或酒精性肝炎病史的门诊患者，进行了一项调查或深入的半结构式访谈。我们有目的地对男性和女性、代偿期和失代偿期患者进行了抽样，以确保在性别和肝脏疾病严重程度方面对定性访谈有足够的代表性。
结果
123 名患者完成了调查，其中 50%报告在过去一年中至少喝过一次酒，而只有 20 名患者正在接受任何形式的当前酒精治疗。在报告过去 3 个月内饮酒的 23 名患者中，目前只有 3 名正在接受 AUD 治疗。17%的患者对饮酒或治疗存在至少一个误解。另有 22 名 ALD 患者（10 名女性，12 名男性）完成了电话访谈，其中三分之二的人自我报告戒酒。所有 22 名访谈参与者都意识到某种形式的酒精治疗，但 13 人认为他们不需要治疗，他们认为治疗无效或“浪费时间”。误解包括对复发药物副作用的不准确认识、认为存在晚期肝病症状意味着治疗酒精使用为时已晚，以及对酒精使用障碍的慢性认识不足。治疗的最常见障碍包括不愿意接受治疗、经济/保险和交通障碍。
结论
尽管许多 ALD 患者有活跃饮酒，但许多患者并未接受酒精使用治疗。量身定制的教育和偏好敏感的治疗参与可能会克服酒精使用治疗的障碍并促进戒酒。
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