Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Alcohol Clin Exp Res. 2021 Jun;45(6):1276-1286. doi: 10.1111/acer.14609. Epub 2021 May 16.
Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD.
Using 2015-2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity.
Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6-8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7-82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9-70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0-12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6-5.6%) who were referred to treatment, and 5.8% (95% CI 5.4-6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity.
Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings-particularly primary care settings-represent a prime opportunity to implement AUD treatment to improve outcomes in this high-risk population.
尽管存在有效的治疗方法，但酒精使用障碍（AUD）的治疗不足。我们使用关怀链框架来了解 AUD 患者关怀中的差距。
使用 2015-2019 年全国药物使用和健康调查数据，我们评估了关怀链中的以下步骤：（1）成人 AUD 的流行率；（2）过去 12 个月内使用过医疗保健的 AUD 成年人比例；（3）筛查 AUD 患者饮酒情况的比例；（4）对 AUD 患者进行酒精滥用简要干预的比例；（5）提供有关酒精滥用治疗信息的 AUD 患者比例；（6）接受治疗的 AUD 患者比例。分析按 AUD 严重程度分层。
在纳入样本的 214505 人中，AUD 的加权流行率为 7.8%（95%CI 7.6-8.0%）。关怀链显示，大多数 AUD 患者在过去 12 个月内使用了医疗保健[81.4%（95%CI 80.7-82.1%）]并接受了关于饮酒的筛查[69.9%（95%CI 68.9-70.8%）]。然而，只有少数人接受了后续的关怀步骤，包括 11.6%（95%CI 11.0-12.2%）报告接受了简短干预，5.1%（95%CI 4.6-5.6%）被转介治疗，5.8%（95%CI 5.4-6.3%）接受了治疗。当按 AUD 严重程度对关怀链进行分层时，观察到类似的模式。
AUD 患者通常会使用医疗保健，并且经常会接受关于饮酒的筛查，但很少接受治疗。医疗保健环境——特别是初级保健环境——为改善这一高危人群的结果提供了实施 AUD 治疗的绝佳机会。
