title: Socioeconomic and geographic disparities in access to pharmacotherapy for alcohol dependence.
abstract: A higher rate of alcohol-attributable morbidity and mortality exists in remote and socioeconomically disadvantaged regions of Australia. This study aimed to explore the dispensing pattern of pharmacotherapy for alcohol dependence across these groups. A retrospective cohort study of patients (aged 15-84) dispensed acamprosate or naltrexone (July 2009-June 2013) was conducted. Observed dispensing rates were obtained for 541 local government areas (LGA) of Australia. Expected dispensing was based on national rates and age standardized to each LGA. Mean dispensing ratios (observed to expected) for each medicine over the period were calculated for remoteness and socioeconomic disadvantaged groups. For both medications, the mean dispensing ratio significantly differed across geographical groups and across socioeconomic groups (p's<0.05). For naltrexone and acamprosate, respectively, the mean dispensing ratio in remote areas was 6 and 9 times less than for the major cities. The mean dispensing ratio for both medications in the most socially disadvantaged areas was approximately 5 times less than that of the most disadvantaged areas. Our data highlight geographical and socioeconomic disparities in Australia regarding access to pharmacological treatment for alcohol use disorder. Targeted strategies aimed at bridging the gap of accessibility for relapse prevention medications are required.
authors.affiliation: NHMRC Centre for Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, NSW, Australia. Electronic address: kirsten.morley@sydney.edu.au.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Morley
authors.affiliation: NHMRC Centre for Research Excellence in Mental Health and Substance Use, Department of Psychology, Macquarie University, NSW, Australia.
authors.forename: Warren
authors.initials: W
authors.lastname: Logge
authors.affiliation: Centre for Big Data Research in Health, UNSW, Australia.
authors.forename: Sallie-Anne
authors.initials: SA
authors.lastname: Pearson
authors.affiliation: NHMRC Centre for Research Excellence in Mental Health and Substance Use, Department of Psychology, Macquarie University, NSW, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Baillie
authors.affiliation: NHMRC Centre for Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, The University of Sydney, NSW, Australia; Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
mesh_terms: D000077443:Acamprosate; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy*; D001315:Australia; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D012189:Retrospective Studies; D012923:Social Class; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate
keywords: Acamprosate; Alcohol dependence; Naltrexone; Pharmacotherapy