Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration.
Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration.
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DOI：
10.1186/1940-0640-8-12
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发表时间：
2013-07-08
影响因子：
3.7
通讯作者：
Harris AH
中科院分区：
文献类型：
--
作者：
Del Re AC;Gordon AJ;Lembke A;Harris AH
作为质量改进指标，美国退伍军人健康管理局（VHA）监测接受FDA批准的酒精依赖药物（纳洛酮、阿坎酸和双硫仑）的酒精使用障碍（AUD）患者的比例。支持抗癫痫药物托吡酯用于治疗酒精依赖的标签外使用的证据可能与这些批准的药物一样强。然而，关于托吡酯在临床实践中的应用程度知之甚少。本研究的目的是描述和检查VHA中AUD患者托吡酯处方的总体使用、使用中的机构水平变化和患者水平预测因素。在一项回顾性队列研究中，我们使用国家VHA管理数据，研究了2009-2012财年（FY）托吡酯使用的时间趋势，以及2011财年在141家VHA机构接受治疗的375，777例AUD（ICD-9-CM代码303.9x或305.0x）患者中托吡酯处方的预测因素。在患有AUD的VHA患者中，托吡酯处方率从2009财年的0.99%增加到2012财年的1.95%，尽管各机构之间存在很大差异。托吡酯处方的预测因素为女性、年轻、酒精依赖诊断、参与精神健康和成瘾专科护理以及精神科合并症。退伍军人健康管理机构监测AUD患者接受FDA批准的药物治疗的程度。在指标中不包括托吡酯，托吡酯的处方频率高于阿坎酸和双硫仑的组合，可能会低估特定机构和整体VHA患者接受AUD药物治疗的程度。
As a quality improvement metric, the US Veterans Health Administration (VHA) monitors the proportion of patients with alcohol use disorders (AUD) who receive FDA approved medications for alcohol dependence (naltrexone, acamprosate, and disulfiram). Evidence supporting the off-label use of the antiepileptic medication topiramate to treat alcohol dependence may be as strong as these approved medications. However, little is known about the extent to which topiramate is used in clinical practice. The goal of this study was to describe and examine the overall use, facility-level variation in use, and patient -level predictors of topiramate prescription for patients with AUD in the VHA. Using national VHA administrative data in a retrospective cohort study, we examined time trends in topiramate use from fiscal years (FY) 2009–2012, and predictors of topiramate prescription in 375,777 patients identified with AUD (ICD-9-CM codes 303.9x or 305.0x) treated in 141 VHA facilities in FY 2011. Among VHA patients with AUD, rates of topiramate prescription have increased from 0.99% in FY 2009 to 1.95% in FY 2012, although substantial variation across facilities exists. Predictors of topiramate prescription were female sex, young age, alcohol dependence diagnoses, engagement in both mental health and addiction specialty care, and psychiatric comorbidity. Veterans Health Administration facilities are monitored regarding the extent to which patients with AUD are receiving FDA-approved pharmacotherapy. Not including topiramate in the metric, which is prescribed more often than acamprosate and disulfiram combined, may underestimate the extent to which VHA patients at specific facilities and overall are receiving pharmacotherapy for AUD.