Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration
Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration
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DOI：
10.1176/ps.2010.61.4.392
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发表时间：
2010-04-01
影响因子：
3.8
通讯作者：
Humphreys, Keith N.
中科院分区：
文献类型：
--
作者：
Harris, Alex H. S.;Kivlahan, Daniel R.;Humphreys, Keith N.
目的：阿坎酸、口服和长效注射用纳曲酮、双硫仑已被批准用于治疗酒精依赖。这些药物的可获得性和在治疗中使用这些药物的考虑，现在已成为高质量护理的标准。这项研究确定了退伍军人健康管理局（VHA）患者的药物启动率。研究方法：VHA药房和管理数据用于确定2006和2007财政年度（FY）诊断为酒精使用障碍的患者以及接受每种药物的比例（全国和各机构）。还检查了与接收相关的患者特征。结果如下：在超过25万被诊断患有酒精使用障碍的患者中，接受任何药物治疗的比例从2006财年的2.8%上升到2007财年的3.0%。接受这些药物治疗的患者更有可能接受专业成瘾治疗，酒精依赖（与滥用相比），年龄小于55岁的患者和女性。在检查的患者亚组中，接受任何药物治疗的最大比例为11.6%。在128个VHA设施中，接受过去年专业成瘾治疗的样本患者的使用率范围为0%至20.5%;没有专业治疗的患者的使用率范围为0%至4.3%。无法根据数据确定患者偏好和医疗禁忌症。结论：研究结果表明，需要更好地了解这些药物的使用和他们的使用作为一个粗略的代理的可用性和考虑的药物治疗，一个标准的护理与强有力的组织支持系统范围内的变化。（精神病学服务61：392-398，2010）
Objective: Acamprosate, oral and long-acting injectable naltrexone, and disulfiram are approved for treatment of alcohol dependence. Their availability and consideration of their use in treatment are now standards of high-quality care. This study determined rates of medication initiation among Veterans Health Administration (VHA) patients. Methods: VHA pharmacy and administrative data were used to identify patients with alcohol use disorder diagnoses in fiscal years (FY) 2006 and 2007 and the proportion (nationally and by facility) who received each medication. Patient characteristics associated with receipt were also examined. Results: Among more than a quarter-million patients with alcohol use disorder diagnoses, the percentage receiving any of the medications increased from 2.8% in FY 2006 to 3.0% in FY 2007. Receipt of these medications was more likely among patients who received specialty addiction care, those with alcohol dependence (compared with abuse), those younger than 55 years, and females. In the patient subgroups examined, the largest proportion to receive any of the medications was 11.6%. Across 128 VHA facilities, rates of use among patients in the sample who had received past-year specialty addiction treatment ranged from 0% to 20.5%; rates ranged from 0% to 4.3% among those with no specialty treatment. Patient preferences and medical contraindications could not be determined from the data. Conclusions: Findings suggest the need to better understand systemwide variation in use of these medications and their use as a rough proxy for availability and consideration of pharmacotherapy-a standard of care with strong organizational support. (Psychiatric Services 61:392-398, 2010)