School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Faculty of Health Sciences and Sport & Institute for Social Marketing, University of Stirling, Stirling, United Kingdom.
Drug Alcohol Rev. 2024 Jul;43(5):1183-1193. doi: 10.1111/dar.13841. Epub 2024 Apr 23.
We assessed the prevalence of prescribing of certain medications for alcohol dependence and the extent of any inequalities in receiving prescriptions for individuals with such a diagnosis. Further, we compared the effectiveness of two of the most prescribed medications (acamprosate and disulfiram) for alcohol dependence and assessed whether there is inequality in prescribing either of them.
We used a nationwide dataset on prescriptions and hospitalisations in Scotland, UK (N = 19,748). We calculated the percentage of patients receiving alcohol dependence prescriptions after discharge, both overall and by socio-economic groups. Binary logistic regressions were used to assess the odds of receiving any alcohol-dependence prescription and the comparative odds of receiving acamprosate or disulfiram. Comparative effectiveness in avoiding future alcohol-related hospitalisations (N = 11,239) was assessed using Cox modelling with statistical adjustment for potential confounding.
Upto 7% of hospitalised individuals for alcohol use disorder received prescriptions for alcohol dependence after being discharged. Least deprived socio-economic groups had relatively more individuals receiving prescriptions. Inequalities in prescribing for alcohol dependence existed, especially across sex and comorbidities: males had 12% (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.81-0.96) and those with a history of mental health hospitalisations had 10% (OR 0.90, 95% CI 0.82-0.98) lower odds of receiving prescriptions after an alcohol-related hospitalisation. Prescribing disulfiram was superior to prescribing acamprosate in preventing alcohol-related hospitalisations (hazard ratio ranged between 0.60 and 0.81 across analyses). Disulfiram was relatively less likely prescribed to those from more deprived areas.
Inequalities in prescribing for alcohol dependence exists in Scotland with lower prescribing to men and disulfiram prescribed more to those from least deprived areas.
我们评估了某些药物治疗酒精依赖的处方率，以及诊断为酒精依赖的个体接受处方的程度。此外，我们比较了两种最常开的药物（安非他酮和双硫仑）治疗酒精依赖的效果，并评估了开其中任何一种药物是否存在不平等。
我们使用了英国苏格兰的一项全国性处方和住院数据（N=19748）。我们计算了出院后接受酒精依赖处方的患者比例，包括总体比例和按社会经济群体划分的比例。二项逻辑回归用于评估接受任何酒精依赖处方的几率以及接受安非他酮或双硫仑的比较几率。使用 Cox 模型评估避免未来与酒精相关的住院（N=11239）的相对效果，并进行了统计学调整以控制潜在的混杂因素。
多达 7%的因酒精使用障碍住院的个体在出院后接受了酒精依赖的处方。社会经济地位最低的群体相对更多的人接受了处方。存在治疗酒精依赖的不平等现象，尤其是在性别和合并症方面：男性的处方几率低 12%（比值比 [OR] 0.88，95%置信区间 [CI] 0.81-0.96），有精神健康住院史的个体的处方几率低 10%（OR 0.90，95% CI 0.82-0.98）。与安非他酮相比，双硫仑在预防酒精相关住院方面效果更好（各种分析中的风险比范围在 0.60 到 0.81 之间）。处方双硫仑的可能性相对较低的是来自较贫困地区的患者。
苏格兰存在治疗酒精依赖的不平等现象，男性的处方率较低，来自较贫困地区的患者双硫仑的处方率较高。
