School of Psychology, Liverpool John Moores University, Liverpool, UK
School of Psychology, Liverpool John Moores University, Liverpool, UK.
BMJ Open. 2023 Apr 19;13(4):e071024. doi: 10.1136/bmjopen-2022-071024.
Liverpool has high prevalence of alcohol use disorders (AUDs) compared with the rest of the UK. Early identification and referral in primary care would improve treatment for people with AUD. This study aimed to identify changes in prevalence and incidence of AUD in primary care in Liverpool, to identify local need for specialist services.
Cross-sectional retrospective analysis of electronic health records.
National Health Service (NHS) Liverpool Clinical Commissioning Group (CCG) primary care. In total, 62 of the 86 general practitioner (GP) practices agreed to share their anonymised Egton Medical Information Systems (EMIS) data from 1 January 2017 to 31 December 2021.
Patients aged over 18 years with a SNOMED code for alcohol dependence (AD) or hazardous drinking (N=4936). Patients were excluded if they had requested that their data was not to be shared, and practices were excluded if they opted out (N=2) or did not respond to the data sharing request (N=22).
Prevalence and incidence of AUD diagnoses in primary care over the 5-year period; demographic profile of patients (sex, age, ethnicity, occupation); GP postcode; alcohol-related medications; and psychiatric and physical comorbidities.
There were significant decreases in incidence of AD and hazardous drinking diagnoses over the 5 years (p<0.001 in all cases). Prevalence showed less change over time. Diagnoses were significantly higher in more deprived areas (Indices of Multiple Deprivation decile 1 vs 2-10). Overall pharmacotherapy prescriptions were lower than national estimates.
There are low levels of identification of AUDs in primary care in Liverpool, and this is decreasing year on year. There was weak evidence to suggest patients in the most deprived areas are less likely to receive pharmacotherapy once diagnosed. Future research should seek to investigate practitioner and patient perspectives on barriers and facilitators to management of AUDs in primary care.
与英国其他地区相比，利物浦的酒精使用障碍（AUD）患病率较高。在初级保健中及早发现和转介可改善 AUD 患者的治疗效果。本研究旨在确定利物浦初级保健中 AUD 的患病率和发病率的变化，以确定对专科服务的本地需求。
电子健康记录的横断面回顾性分析。
NHS 利物浦临床委托组（CCG）的初级保健。共有 86 家全科医生（GP）实践中的 62 家同意分享他们从 2017 年 1 月 1 日至 2021 年 12 月 31 日的匿名 Egton Medical Information Systems（EMIS）数据。
年龄在 18 岁以上，具有酒精依赖（AD）或危险饮酒 SNOMED 代码的患者（N=4936）。如果患者要求不共享其数据，则将其排除在外，如果实践选择退出（N=2）或未响应数据共享请求（N=22），则将其排除在外。
5 年内初级保健中 AUD 诊断的患病率和发病率；患者的人口统计学特征（性别、年龄、种族、职业）；GP 邮政编码；与酒精相关的药物；以及精神和身体合并症。
在 5 年内，AD 和危险饮酒诊断的发病率均显著下降（所有情况下均<0.001）。随着时间的推移，患病率的变化较小。在较贫困地区（综合贫困指数第 1 分位与 2-10 分位）诊断率更高。总体药物治疗处方低于全国估计数。
利物浦初级保健中 AUD 的识别率较低，且逐年下降。有微弱的证据表明，在最贫困地区诊断出的患者接受药物治疗的可能性较低。未来的研究应致力于调查从业者和患者对初级保健中 AUD 管理的障碍和促进因素的看法。
