Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.
Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.
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DOI：
10.1186/s13722-016-0063-8
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发表时间：
2016-09-15
影响因子：
3.7
通讯作者：
Christopher M
中科院分区：
文献类型：
--
作者：
Harris AH;Bowe T;Hagedorn H;Nevedal A;Finlay AK;Gidwani R;Rosen C;Kay C;Christopher M
积极考虑有效的药物治疗酒精使用障碍（AUD）是一个共识的护理标准，但这些药物的知识和使用在不同的环境中非常低。这项研究评估了一个多方面的学术详细计划的整体有效性，以解决美国退伍军人健康管理局（VHA）的这一持续存在的质量问题，以及解释不同地点有效性差异的背景和过程因素。采用中断时间序列设计，采用混合效应分段logistic回归分析，评估接受纳洛酮、阿坎酸、双硫仑或托吡酯治疗的临床记录AUD患者每月百分比的水平变化和变化率。使用实施后20个月的数据，将干预研究中心（n = 37）与其实施前16个月的性能进行比较，并分别与VHA的其他部分进行比较。从干预前即刻到观察期结束，干预中心接受药物治疗的AUD患者百分比绝对增加了3.4%，相对增加了68%（即，4.9- 8.3%）。这一变化是显着的干预网站和控制网站的长期趋势相比，实施前的时期。实施前采用率较低的研究中心，详细说明的工时较多，但详细说明的人较少，实施后药物接收量立即增加。随着时间的推移，每个人的平均细节遭遇次数与斜率的急剧增加有关。这项研究发现了一个多方面的质量改进策略，旨在增加获得和利用药物治疗AUD的实证支持。未来的研究应该集中在确定如何提高程序的效果，特别是在非响应位置。
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.