英格兰预防酒精复发处方药物的相关因素和程度。

The correlates and extent of prescribing of medications for alcohol relapse prevention in England.

机构信息

Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.

Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

出版信息

Addiction. 2021 Nov;116(11):3019-3026. doi: 10.1111/add.15502. Epub 2021 May 4.

DOI:10.1111/add.15502

PMID:33788332

Abstract

AIMS

To determine the pattern and extent of prescribing of medications for alcohol relapse prevention (ARP) in England.

DESIGN

Cross-sectional.

SETTING

Specialist drug and alcohol treatment providers in England reporting to the National Drug Treatment Monitoring System.

PARTICIPANTS

Service users aged 18+, with alcohol the primary substance of dependence, completing a treatment journey between April 2013 and March 2016 (n = 188 152).

MEASUREMENTS

Prescription of medications for ARP during a treatment journey. Data on service users' demographics, treatment and clinical characteristics were extracted.

FINDINGS

The rate of prescribing medications for ARP was 2.1% in 2013/14, 6.8% in 2014/15 and 7.8% in 2015/16. A greater likelihood of prescription was associated with treatment journey year [2014/15; adjusted odds ratio (aOR) = 3.269, 95% confidence intervals (CI) = 3.044-3.510, 2015/16; aOR = 3.823, CI = 3.560-4.106], age (25-34; aOR = 1.622, CI = 1.380-1.907, 35-54; aOR = 1.901, CI = 1.628-2.220 or 55+; aOR = 1.700, CI = 1.446-1.999), female gender (aOR = 1.129, CI = 1.077-1.184), white ethnicity (aOR = 1.219, CI = 1.077-1.380), regional prevalence of alcohol dependence (middle rate; aOR = 1.121, CI = 1.024-1.228), severity of alcohol dependence (moderate dependence without complex needs; aOR = 1.329, CI = 1.244-1.419, severe dependence without complex needs; aOR = 1.308, CI = 1.188-1.441, moderate/severe dependence with complex needs; aOR = 1.131, CI = 1.020-1.255), treatment setting (inpatient; aOR = 10.512, CI = 9.950-11.104, primary care; aOR = 2.264, CI = 2.050-2.500, residential; aOR = 3.216, CI = 2.807-3.685), prior treatment for alcohol dependence (aOR = 1.242, CI = 1.183-1.304), longer treatment journey (aOR = 1.002, CI = 1.002-1.002), more drinking days in the prior 28 days (aOR = 1.021, CI = 1.018-1.024) and drinking a higher number of alcohol units in the prior 28 days (aOR = 1.002 CI = 1.001-1.004). Living in a region of England with the lowest alcohol prevalence was associated with a lower likelihood of prescription of medication for aRP (AOR = 0.491, CI = 0.436-0.552).

CONCLUSIONS

In England, medications for alcohol relapse prevention are rarely prescribed (e.g. 7.8% in 2015/16) and those prescriptions appear to be associated with specific service user demographics, treatment and clinical characteristics.

摘要

目的

确定英格兰预防酒精复饮药物处方的模式和范围。

设计

横断面研究。

地点

向国家药物治疗监测系统报告的英国专业毒品和酒精治疗提供者。

参与者

2013 年 4 月至 2016 年 3 月期间完成治疗旅程的年龄在 18 岁及以上、酒精为主要依赖物质的服务使用者（n=188152）。

测量方法

在治疗旅程中开预防酒精复饮药物的处方。提取了有关服务使用者人口统计学、治疗和临床特征的数据。

结果

2013/14 年、2014/15 年和 2015/16 年预防酒精复饮药物处方率分别为 2.1%、6.8%和 7.8%。治疗旅程年份与处方的可能性更大相关（2014/15 年；调整优势比[aOR]为 3.269，95%置信区间[CI]为 3.044-3.510；2015/16 年；aOR 为 3.823，CI 为 3.560-4.106）、年龄（25-34 岁；aOR 为 1.622，CI 为 1.380-1.907 岁；35-54 岁；aOR 为 1.901，CI 为 1.628-2.220 岁；55 岁及以上；aOR 为 1.700，CI 为 1.446-1.999）、女性性别（aOR 为 1.129，CI 为 1.077-1.184）、白人种族（aOR 为 1.219，CI 为 1.077-1.380）、英格兰地区酒精依赖流行率（中流行率；aOR 为 1.121，CI 为 1.024-1.228）、酒精依赖严重程度（无复杂需求的中度依赖；aOR 为 1.329，CI 为 1.244-1.419 岁；无复杂需求的严重依赖；aOR 为 1.308，CI 为 1.188-1.441 岁；有复杂需求的中重度依赖；aOR 为 1.131，CI 为 1.020-1.255）、治疗环境（住院；aOR 为 10.512，CI 为 9.950-11.104；初级保健；aOR 为 2.264，CI 为 2.050-2.500；住院；aOR 为 3.216，CI 为 2.807-3.685）、既往酒精依赖治疗（aOR 为 1.242，CI 为 1.183-1.304）、治疗旅程较长（aOR 为 1.002，CI 为 1.002-1.002）、过去 28 天内饮酒天数较多（aOR 为 1.021，CI 为 1.018-1.024）和过去 28 天内饮酒量较多（aOR 为 1.002，CI 为 1.001-1.004）。居住在英格兰酒精流行率最低的地区与预防酒精复饮药物处方的可能性降低相关（aOR 为 0.491，CI 为 0.436-0.552）。