Bernstein Eden Y, Pfoh Elizabeth R, Le Phuc, Rothberg Michael B
Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH 44195, USA.
Center for Value-Based Care Research, Cleveland Clinic.
Alcohol Alcohol. 2023 Jan 9;58(1):54-59. doi: 10.1093/alcalc/agac057.
Acamprosate, naltrexone and disulfiram are underprescribed for alcohol use disorder (AUD) with marked variability among primary care providers (PCPs). We aimed to identify differences between high and low prescribers of medications for AUD (MAUD) with regard to knowledge, experiences, prioritization and attitudes.
We surveyed PCPs from a large healthcare system with at least 20 patients with AUD. Prescribing rates were obtained from the electronic health record (EHR). Survey responses were scored from strongly disagree (1) to strongly agree (5). Multiple imputation was used to generate attitude scores for 7 missing subjects. PCPs were divided into groups by the median prescribing rate and attitude. Comparisons were made using Wilcoxon rank-sum and regression.
Of the 182 eligible PCPs, 68 (37.4%) completed the survey. Most indicated willingness to attend an educational course (57.4%). Compared with low prescribers, high prescribers viewed the effectiveness of medications more favorably (short term 4.0 vs 3.7, P = 0.02; long term 3.5 vs 3.2, P = 0.04) and were more likely to view prescribing as part of their job (3.9 vs 3.4, P = 0.04). PCPs with positive attitudes (72.4%, CI 60.9-83.8%) had a prescribing rate of 5.0% (CI 3.5-6.5%) compared to 1.9% (CI 0.5-3.4%) among those with negative attitudes (P = 0.028). When stratified by attitude, belief in effectiveness was associated with higher prescribing among PCPs with positive attitudes but not those with negative attitudes.
PCPs indicated an interest in learning to prescribe MAUD. However, education alone may not be effective unless physicians have positive attitudes towards patients with AUD.
对于酒精使用障碍（AUD），阿坎酸、纳曲酮和双硫仑的处方量不足，且初级保健提供者（PCP）之间存在显著差异。我们旨在确定AUD药物（MAUD）高处方者和低处方者在知识、经验、优先级和态度方面的差异。
我们对来自一个大型医疗系统的PCP进行了调查，这些PCP至少有20名AUD患者。处方率从电子健康记录（EHR）中获取。调查回复从强烈不同意（1）到强烈同意（5）进行评分。使用多重插补法为7名缺失受试者生成态度得分。PCP按处方率中位数和态度分为几组。使用Wilcoxon秩和检验和回归进行比较。
在182名符合条件的PCP中，68名（37.4%）完成了调查。大多数人表示愿意参加教育课程（57.4%）。与低处方者相比，高处方者对药物有效性的看法更积极（短期4.0对3.7，P = 0.02；长期3.5对3.2，P = 0.04），并且更有可能将开处方视为其工作的一部分（3.9对3.4，P = 0.04）。态度积极的PCP的处方率为5.0%（CI 3.5 - 6.5%），而态度消极的PCP的处方率为1.9%（CI 0.5 - 3.4%）（P = 0.028）。按态度分层时，对有效性的信念与态度积极的PCP中较高的处方率相关，但与态度消极的PCP无关。
PCP表示有兴趣学习开具MAUD处方。然而，除非医生对AUD患者有积极态度，仅靠教育可能无效。
