NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Dubbo, Australia.
Drug Alcohol Rev. 2023 Nov;42(7):1606-1616. doi: 10.1111/dar.13708. Epub 2023 Jul 9.
Alcohol dependence is a chronic condition impacting millions of individuals worldwide. Safe and effective medicines to reduce relapse can be prescribed by general practitioners but are underutilised in the general Australian population. Prescription rates of these medicines to Aboriginal and Torres Strait Islander (First Nations) Australians in primary care are unknown. We assess these medicines in Aboriginal Community Controlled Health Services and identify factors associated with prescription.
Baseline data (spanning 12 months) were used from a cluster randomised trial involving 22 Aboriginal Community Controlled Health Services. We describe the proportion of First Nations patients aged 15+ who were prescribed a relapse prevention medicine: naltrexone, acamprosate or disulfiram. We explore associations between receiving a prescription, a patient AUDIT-C score and demographics (gender, age, service remoteness) using logistic regression.
During the 12-month period, 52,678 patients attended the 22 services. Prescriptions were issued for 118 (0.2%) patients (acamprosate n = 62; naltrexone n = 58; disulfiram n = 2; combinations n = 4). Of the total patients, 1.6% were 'likely dependent' (AUDIT-C ≥ 9), of whom only 3.4% received prescriptions for these medicines. In contrast, 60.2% of those who received a prescription had no AUDIT-C score. In multivariate analysis, receiving a script (OR = 3.29, 95% CI 2.25-4.77) was predicted by AUDIT-C screening, male gender (OR = 2.24, 95% CI 1.55-3.29), middle age (35-54 years; OR = 14.41, 95% CI 5.99-47.31) and urban service (OR = 2.87, 95% CI 1.61-5.60).
Work is needed to increase the prescription of relapse prevention medicines when dependence is detected. Potential barriers to prescription and appropriate ways to overcome these need to be identified.
酒精依赖是一种影响全球数百万人的慢性疾病。全科医生可以开出安全有效的减少复发的药物，但在澳大利亚普通人群中并未得到充分利用。在初级保健中，开给原住民和托雷斯海峡岛民（第一民族）的这些药物的处方率尚不清楚。我们在原住民社区控制的医疗服务机构中评估这些药物，并确定与处方相关的因素。
本研究使用了一项涉及 22 个原住民社区控制的医疗服务机构的集群随机试验的基线数据（跨度为 12 个月）。我们描述了年龄在 15 岁及以上的第一民族患者中被开预防复发药物的比例：纳曲酮、阿坎酸或双硫仑。我们使用逻辑回归探讨了接受处方、患者 AUDIT-C 评分和人口统计学（性别、年龄、服务偏远程度）之间的关联。
在 12 个月期间，22 个服务机构共接待了 52678 名患者。为 118 名（0.2%）患者开具了处方（阿坎酸 62 名；纳曲酮 58 名；双硫仑 2 名；联合用药 4 名）。在总患者中，1.6%为“可能依赖”（AUDIT-C≥9），其中只有 3.4%的患者开了这些药物的处方。相比之下，60.2%接受处方的患者没有 AUDIT-C 评分。在多变量分析中，接受处方（OR=3.29，95%CI 2.25-4.77）的预测因素是 AUDIT-C 筛查、男性（OR=2.24，95%CI 1.55-3.29）、中年（35-54 岁；OR=14.41，95%CI 5.99-47.31）和城市服务（OR=2.87，95%CI 1.61-5.60）。
需要努力增加依赖检测时预防复发药物的处方。需要确定处方的潜在障碍以及克服这些障碍的适当方法。
