title: Enhancing access to alcohol use disorder pharmacotherapy and treatment in primary care settings: ADaPT-PC.
abstract: BACKGROUND
  Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation components.
  
  
  METHODS
  Three large Veterans Health Administration (VHA) facilities are participating in the intervention. The intervention targets stakeholder groups with tailored strategies based on implementation theory and prior research identifying barriers to implementation of AUD pharmacotherapy. Local SUD providers and primary care mental health integration (PCMHI) providers are trained to serve as local implementation/clinical champions and receive external facilitation. PC providers receive access to consultation from local and national clinical champions, educational materials, and a dashboard of patients with AUD on their caseloads for case identification. Veterans with AUD diagnoses receive educational information in the mail just prior to a scheduled PC visit. Effectiveness of the intervention will be evaluated through an interrupted time series with matched controls to monitor change in facility level AUD pharmacotherapy prescribing rates. Following Stetler's four-phase formative evaluation (FE) strategy, FE methods include (1) developmental FE (pre-implementation interviews with champions, PC providers, and Veterans), (2) implementation-focused FE (tracking attendance at facilitation meetings, academic detailing efforts by local champions, and patient dashboard utilization), (3) progress-focused FE (tracking rates of AUD pharmacotherapy prescribing and rates of referral to PCMHI and SUD specialty care), and (4) interpretive FE (post-implementation interviews with champions and PC providers). Analysis of FE data will be guided by the Consolidated Framework for Implementation Research (CFIR).
  
  
  CONCLUSIONS
  If demonstrated to be successful, this implementation strategy will provide a replicable, feasible, and relative low-cost method for integrating AUD treatment services into PC settings, thereby increasing access to AUD treatment.
authors.affiliation: Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA. hildi.hagedorn@va.gov.|Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA. hildi.hagedorn@va.gov.
authors.forename: Hildi J
authors.initials: HJ
authors.lastname: Hagedorn
authors.affiliation: William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.|Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53715, USA.
authors.forename: Randall
authors.initials: R
authors.lastname: Brown
authors.affiliation: Substance Abuse Treatment Program, South Texas Veterans Affairs Health Care System, San Antonio, TX, 78229, USA.|Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Dawes
authors.affiliation: Veterans Affairs Health Services Research and Development Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, 55417, USA.|Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, 55455, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Dieperink
authors.affiliation: Center for Drug and Alcohol Problems, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, 29401, USA.|Department of Psychiatry and Behavioral Services, Medical University of South Carolina, Charleston, SC, 29425, USA.
authors.forename: Donald Hugh
authors.initials: DH
authors.lastname: Myrick
authors.affiliation: Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Oliva
authors.affiliation: Health Economics Resource Center, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Department of Health Policy, George Washington University, Washington, DC, 20052, USA.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Wisdom
authors.affiliation: Veterans Affairs Health Services Research and Development Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, CA, 94025, USA.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
mesh_terms: D019973:Alcohol-Related Disorders / Q000188:drug therapy* / Q000628:therapy; D005240:Feasibility Studies; D006284:Health Plan Implementation; D006297:Health Services Accessibility; D006801:Humans; D011320:Primary Health Care / Q000379:methods*
keywords: Alcohol use disorder pharmacotherapy; Alcohol use disorder treatment; Implementation; Primary care mental health integration