title: Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.
abstract: Active consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted academic detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites.
  
  
  
  An interrupted time series design, analyzed with mixed-effects segmented logistic regression, was used to evaluate changes in level and rate of change in the monthly percent of patients with a clinically documented AUD who received naltrexone, acamprosate, disulfiram, or topiramate. Using data from a 20 month post-implementation period, intervention sites (n = 37) were compared to their own 16 month pre-implementation performance and separately to the rest of VHA.
  
  
  
  From immediately pre-intervention to the end of the observation period, the percent of patients in the intervention sites with AUD who received medication increased over 3.4 % in absolute terms and 68 % in relative terms (i.e., 4.9-8.3 %). This change was significant compared to the pre-implementation period in the intervention sites and secular trends in control sites. Sites with lower pre-implementation adoption, more person hours of detailing, but fewer people detailed, had larger immediate increases in medication receipt after implementation. The average number of detailing encounters per person was associated with steeper increases in slope over time.
  
  
  
  This study found empirical support for a multifaceted quality improvement strategy aimed at increasing access to and utilization of pharmacotherapy for AUD. Future studies should focus on determining how to enhance the programs effects, especially in non-responsive locations.
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA. Alexander.Harris2@va.gov.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bowe
authors.affiliation: Center for Chronic Disease Outcomes Research, Health Services Research and Development, VA Minneapolis Health Care System, Minneapolis, MN, USA.
authors.forename: Hildi
authors.initials: H
authors.lastname: Hagedorn
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Nevedal
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Finlay
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Risha
authors.initials: R
authors.lastname: Gidwani
authors.affiliation: Center for Innovation to Implementation, Health Services Research and Development, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Rosen
authors.affiliation: Pharmacy Benefits Management, Academic Detailing Program, VA San Diego Health Care System, San Diego, CA, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Kay
authors.affiliation: Pharmacy Benefits Management, Academic Detailing Program, VA San Diego Health Care System, San Diego, CA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Christopher
mesh_terms: D000077443:Acamprosate; D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage*; D019973:Alcohol-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D004221:Disulfiram / Q000008:administration & dosage; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage; D010349:Patient Compliance / Q000706:statistics & numerical data*; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077236:Topiramate; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000427:Alcohol Deterrents; D000077236:Topiramate; D013654:Taurine; D005632:Fructose; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram
keywords: Alcohol use disorder; Guideline adherence; Implementation; Medication assisted treatment; Pharmacotherapy; Practice guidelines; Quality improvement