Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system.
Medication prescribing for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system.
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DOI：
10.1111/acer.14837
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发表时间：
2022-06
期刊：
影响因子：
--
通讯作者：
Jolley, Sarah E.
中科院分区：
文献类型：
--
作者：
Chockalingam, Leela;Burnham, Ellen L.;Jolley, Sarah E.
调查显示，治疗酒精使用障碍 (MAUD) 的药物可以减少酗酒和复发。然而，只有 1.6% 的酒精使用障碍 (AUD) 患者在各个护理机构中接受 MAUD。急性护理环境中 MAUD 处方的流行病学描述不完整。我们假设，与门诊、急诊室 (ED) 和住院药物使用治疗环境相比，住院急症护理医院环境中 MAUD 的处方量会不足。我们评估了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间在科罗拉多大学健康 (UCHealth) 系统中进行国际疾病分类第 10 版 (ICD-10) 酒精相关诊断的成年患者的电子健康记录 (EHR) 数据。具有阿片类药物使用障碍 ICD-10 诊断代码的患者以及在首次酒精相关发作之前接受 MAUD 的患者的数据被排除在外。主要结局是 MAUD 处方，定义为纳曲酮、阿坎酸和/或双硫仑处方。我们进行了双变量和多变量分析，以确定 UCHealth 开具 MAUD 处方的独立预测因素。我们在 UCHealth 确定了 48,421 名独特的患者，他们有 136,205 次与酒精相关的遭遇。遭遇发生在急诊室 (42%)、住院急症护理 (17%)、住院药物滥用治疗 (18%) 或门诊初级护理 (12%) 环境中。在所有环境中，只有 2270 名 (5%) 患者接受了 MAUD。女性性与成瘾医学咨询积极预测 MAUD 处方。相比之下，住院患者药物使用治疗之外的遭遇、西班牙裔以及黑人或非白人种族是 MAUD 处方的负面预测因素。与住院患者物质使用治疗相比，因 AUD 住院的急性护理住院患者接受 MAUD 的几率降低了 93%。在我们的医疗保健系统中，与 AUD 相关的 ED 和住院急症护理医院的情况很常见。然而，MAUD 处方在该人群中并不常见，特别是在住院环境中。我们的研究结果表明，在急症护理机构中对酒精相关诊断的患者启动 MAUD 值得进行额外评估。
Investigations show medications for alcohol use disorders (MAUD) reduce heavy-drinking and relapses. However, only 1.6% of individuals with alcohol use disorders (AUD) receive MAUD across care settings. The epidemiology of MAUD prescribing in the acute care setting is incompletely described. We hypothesized that MAUD would be under-prescribed in inpatient acute care hospital settings compared to the outpatient, emergency department (ED), and inpatient substance use treatment settings. We evaluated electronic health record (EHR) data from adult patients with an International Classification of Diseases 10th revision (ICD-10) alcohol-related diagnosis in the University of Colorado Health (UCHealth) system between 1/1/2016 – 12/31/2019. Data from patients with an ICD-10 diagnosis code for opioid use disorder and those receiving MAUD prior to their first alcohol-related episode were excluded. The primary outcome was prescribing of MAUD, defined by prescription of naltrexone, acamprosate, and/or disulfiram. We performed bivariate and multivariate analysis to identify independent predictors of MAUD prescribing at UCHealth. We identified 48,421 unique patients with 136,205 alcohol-related encounters at UCHealth. Encounters occurred in the ED (42%), inpatient acute care (17%), inpatient substance use treatment (18%), or outpatient primary care (12%) settings. Only 2270 (5%) patients received MAUD across all settings. Female sex and addiction medicine consults positively predicted MAUD prescribing. In contrast, encounters outside inpatient substance use treatment, Hispanic ethnicity, and black or non-white race were negative predictors of MAUD prescribing. Compared to inpatient substance use treatment, inpatient acute care hospitalizations for AUD was associated with a 93% reduction in the odds of receiving MAUD. AUD-related ED and inpatient acute care hospital encounters in our healthcare system were common. Nevertheless, prescriptions for MAUD were infrequent in this population, particularly in inpatient settings. Our findings suggest that initiation of MAUD for patients with alcohol-related diagnoses in the acute care settings deserves additional evaluation.
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DOI：
10.1111/acer.13410
发表时间：
2017-07
期刊：
Alcoholism, clinical and experimental research
影响因子：
--
作者：
Busch AC;Denduluri M;Glass J;Hetzel S;Gugnani SP;Gassman M;Krahn D;Deyo B;Brown R
通讯作者：
Brown R
DOI：
10.1016/j.mayocpiqo.2021.01.013
发表时间：
2021-04
期刊：
Mayo Clinic proceedings. Innovations, quality & outcomes
影响因子：
--
作者：
Kirchoff RW;Mohammed NM;McHugh J;Markota M;Kingsley T;Leung J;Burton MC;Chaudhary R
通讯作者：
Chaudhary R
影响因子：
5.5
作者：
Bouchery, Ellen E.;Harwood, Henrick J.;Brewer, Robert D.
通讯作者：
Brewer, Robert D.
影响因子：
4.7
作者：
Borland, Ron;Yong, Hua-Hie;Fong, Geoffrey T.
通讯作者：
Fong, Geoffrey T.
影响因子：
3.8
作者：
Harris, Alex H. S.;Kivlahan, Daniel R.;Humphreys, Keith N.
通讯作者：
Humphreys, Keith N.