Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence
Pharmacotherapy of Alcohol Use Disorders by the Veterans Health Administration: Patterns of Receipt and Persistence
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DOI：
10.1176/appi.ps.201000553
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发表时间：
2012-07-01
影响因子：
3.8
通讯作者：
Trafton, Jodie A.
中科院分区：
文献类型：
--
作者：
Harris, Alex H. S.;Oliva, Elizabeth;Trafton, Jodie A.
目的：本研究评估了自2007年以来退伍军人健康管理局（VHA）机构（N=129）在使用美国食品和药物管理局批准用于治疗酒精使用障碍的药物方面的变化。方法：使用2008和2009财政年度（FYs）的VHA数据来识别被诊断为酒精使用障碍的患者，这些患者接受了口服或缓释纳曲酮、双硫仑或阿坎前列酯，以及开始治疗后180天内覆盖天数（PDC）的比例，以及每种药物的前10天持有时间（持续时间）。多水平、混合效应logistic回归模型检验了患者和机构特征与药物使用之间的关系。结果：在全国范围内，3.4%的酒精使用障碍的VHA患者在2009财政年度接受了药物治疗（331,635名患者中的11,165名），高于2007财政年度的3.0%。患者在这些设施中使用药物的比例从0%到12%不等。在完全调整后的分析中，提供晚间和周末服务的设施有更高的药物收收率，但其他设施的特征，如在成瘾项目的工作人员中有处方者或使用药物治疗阿片类药物或烟草依赖，与药物收收率无关。阿坎前列酸的平均PDC值明显低于其他药物的平均PDC值（p . 2）
Objective: This study assessed changes since 2007 at Veterans Health Administration (VHA) facilities (N=129) in use of the medications approved by the U.S. Food and Drug Administration for treatment of alcohol use disorders. Methods: VHA data from fiscal years (FYs) 2008 and 2009 were used to identify patients with a diagnosis of an alcohol use disorder who received oral or extended-release naltrexone, disulfiram, or acamprosate as well as the proportion of days covered (PDC) in the 180 days after initiation and the time to first ten-day gap in possession (persistence) for each medication. Multilevel, mixed-effects logistic regression models examined the association between patient and facility characteristics and use of medications. Results: Nationally, 3.4% of VHA patients with an alcohol use disorder received medications in FY 2009 (11,165 of 331,635 patients), up from 3.0% in FY 2007. Use of medications by patients at the facilities ranged from 0% to 12%. In fully adjusted analyses, facilities offering evening and weekend services had higher rates of medication receipt, but other facility characteristics, such as having prescribers on the addiction program's staff or using medication to treat opioid or tobacco dependence, were unrelated to medication receipt. The mean PDC of acamprosate was significantly lower than mean PDCs of the other medications (p