Volume 10 Supplement 2

INEBRIA 12th Congress,

Open Access

Barriers and facilitators to pharmacotherapy for alcohol use disorders in primary care: results of a qualitative study in 4 va primary care clinics

  • Emily Williams1, 2Email author,
  • CE Achtmeyer1, 5,
  • JP Young1,
  • KA Bradley2, 3, 4,
  • D Berger5,
  • MB Siegel6,
  • G Curran7,
  • EJ Ludman4,
  • GT Lapham4,
  • AHS Harris8 and
  • M Forehand9
Addiction Science & Clinical Practice201510(Suppl 2):P12

DOI: 10.1186/1940-0640-10-S2-P12

Published: 24 September 2015

Background

In the context of routine population-based alcohol screening to identify primary care (PC) patients who might benefit from brief intervention, many patients identified will have alcohol use disorders (AUD)[1] and will likely require more intensive treatments. FDA approved medications are recommended to treat AUD[2]b and could be offered in PC. Currently, use of AUD medications is extremely rare.[3] This qualitative study sought to understand barriers and facilitators to prescribing AUD medications in PC.

Material and methods

Key contacts and snowball sampling were used to recruit 23 PC providers (MDs and NPs) from 4 Veterans Health Administration (VA) clinics. Providers completed semi-structured interviews in person, which were recorded, transcribed, and analyzed using rapid team-based qualitative methods.

Results

Few participating providers had prescribed AUD medications. Providers consistently reported concern regarding lack of time to adequately address AUD, need for training in prescribing AUD medications, and need for ongoing support from mental health or on-site staff to provide behavioral counseling. However, some participating providers were more willing than others to consider prescribing AUD medications. Providers who were more willing viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective “tool” or “foot in the door” for treating AUD, and believed that providing AUD medications in PC may catalyze change while reducing stigma and other barriers to specialty addictions treatment. Those who were less willing believed that substantial programmatic changes would be needed to facilitate provision of AUD medications in PC, had less belief in the ability of “pills” to treat AUD, and believed AUD treatment was best left to specialty settings.

Conclusions

With training and additional behavioral staff, it may be possible to capitalize on some providers' willingness and optimism to increase provision of medications as part of PC for patients with AUD.

Declarations

Acknowledgements

The authors gratefully acknowledge the participants of this study for allowing us to solicit and report on their perspectives. We also thank the clinical and administrative coordinators at each of the clinics for facilitating our visits. This study was funded by VA Health Services Research & Development and VA Quality Enhancement Research Initiative (RRP 12-528; Williams PI). Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276). Dr. Bradley's time on this study was supported by the Center of Excellence for Substance Abuse Treatment and Education (CESATE) at VA Puget Sound.

Authors’ Affiliations

(1)
Center of Innovation for Veteran-Centered Value-Driven Care, Health Services Research & Development, Veterans Affairs Puget Sound Health Care System
(2)
Department of Health Services, School of Public Health, University of Washington
(3)
Group Health Research Instistute
(4)
Department of Medicine, School of Medicine, University of Washington
(5)
Primary and Specialty Care Medicine, Veterans Affiars Puget Sound Health Care System
(6)
Department of Social and Behavioral Sciences, School of Public Health, Boston University
(7)
Division of Health Services Research, Department of Psychiatry, University of Arkansas for Medical Sciences
(8)
Palo Alto Health Care System, Veterans Health Administration
(9)
Foster School of Business, University of Washington

References

  1. Williams EC, Rubinsky AD, Lapham GT, Hawkins EJ, Chavez LJ, Rittmueller SE, Hawkins EJ, Grossbard J, Kivlahan DR, Bradley KA: Prevalence of Recognized Alcohol and Other Substance Use Disorders among VA Outpatients with Unhealthy Alcohol Use Identified by Routine Alcohol Screening. Drug and Alcohol Dependence. 2014, 135: 95-103.View ArticlePubMedGoogle Scholar
  2. NIAAA: Helping Patients Who Drink Too Much: A Clinician's Guide (Updated 2005 Edition). 2007, Washington, D.C.: NIH, US DHHSGoogle Scholar
  3. Harris AH, Kivlahan DR, Bowe T, et al: Pharmacotherapy of alcohol use disorders in the Veterans Health Administration. Psychiatr Serv. 2010, 61: 392-8. 10.1176/ps.2010.61.4.392.View ArticlePubMedGoogle Scholar

Copyright

© Williams et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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