Pharmacotherapy for alcohol dependence: perceived treatment barriers and action strategies among Veterans Health Administration service providers.
Although access to and consideration of pharmacological treatments for alcohol dependence are consensus standards of care, receipt of these medications by patients is generally rare and highly variable across treatment settings. The goal of the present project was to survey and interview the clinicians, managers, and pharmacists affiliated with addiction treatment programs within Veterans Health Administration (VHA) facilities to learn about their perceptions of barriers and facilitators regarding greater and more reliable consideration of pharmacological treatments for alcohol dependence. Fifty-nine participants from 19 high-adopting and 11 low-adopting facilities completed the survey (facility-level response rate = 50%) and 23 participated in a structured interview. The top 4 barriers to increased consideration and use of pharmacotherapy for alcohol dependence were consistent across high- and low-adopting facilities and included perceived low patient demand, pharmacy procedures or formulary restrictions, lack of provider skills or knowledge regarding pharmacotherapy for alcohol dependence, and lack of confidence in treatment effectiveness. Low patient demand was rated as the most important barrier for oral naltrexone and disulfiram, whereas pharmacy or formulary restrictions were rated as the most important barrier for acamprosate and extended-release naltrexone. The 4 strategies rated across low- and high-adopting facilities as most likely to facilitate consideration and use of pharmacotherapy for alcohol dependence were more education to patients about existing medications, more education to health care providers about medications, increased involvement of physicians in treatment for alcohol dependence, and more compelling research on existing medications. This knowledge provides a foundation for designing, deploying, and evaluating targeted implementation efforts.
Center for Health Care Evaluation.
Alex H S
AHS
Harris
Center for Health Care Evaluation.
Laura
L
Ellerbe
Center for Health Care Evaluation.
Rachelle N
RN
Reeder
Center for Health Care Evaluation.
Thomas
T
Bowe
VISN 4 Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Health Care System.
Adam J
AJ
Gordon
Center for Chronic Disease Outcomes Research, VA Minneapolis Health Care System.
Hildi
H
Hagedorn
Center for Health Care Evaluation.
Elizabeth
E
Oliva
Department of Psychiatry, Stanford University.
Anna
A
Lembke
Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System.
Daniel
D
Kivlahan
Center for Health Care Evaluation.
Jodie A
JA
Trafton
D000077443:Acamprosate; D000328:Adult; D000368:Aged; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D004221:Disulfiram / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005569:Formularies as Topic; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000706:statistics & numerical data
D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram