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Role of Health Care in Addressing Unhealthy Alcohol Use and Disparities among Aging Women

医疗保健在解决老年妇女不健康饮酒和差异方面的作用

基本信息

批准号：
10505016
负责人：
CYNTHIA I CAMPBELL
金额：
$ 63.31万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-16 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10505016
关键词：
Address Adherence Age Age-Years Aging Alcohol abuse Alcohol consumption Alcohols Antidepressive Agents Antihypertensive Agents Anxiety Benzodiazepines Caring Caucasians Clinical Comprehensive Health Care Data Diabetes Mellitus Discipline of obstetrics Elderly Electronic Health Record Ethnic Origin Ethnic group Exercise Face Funding Geriatrics Guidelines Gynecology Health Health Personnel Health Services Health Services Accessibility Health behavior Health system Healthcare Healthcare Systems Hypertension Hypoglycemia Individual Interpersonal Violence Intervention Interview Medical Medicine Mental Depression Methods Minority Women Modeling National Institute on Alcohol Abuse and Alcoholism Older Population Opioid Pain Patient Self-Report Patients Pharmaceutical Preparations Primary Health Care Provider Psychiatric Diagnosis Psychiatry Public Health Race Registries Reporting Research Research Priority Risk Risk Factors Role Services System Testing Time Tobacco United States Visit Vulnerable Populations Woman Work addiction adverse outcome age group aging population alcohol effect alcohol intervention alcohol misuse alcohol screening alcohol use disorder baby boomer barrier to care binge drinking brief alcohol intervention brief intervention care systems causal model chronic pain clinical diagnostics clinical risk drinking early alcohol use effective intervention ethnic difference experience follow-up health care delivery health care service utilization health service use high risk holistic approach improved indexing innovation intersectionality medical specialties member men middle age negative affect older women people of color prescription opioid racial and ethnic racial and ethnic disparities reduced alcohol use screening screening program theories treatment strategy trend

项目摘要

ABSTRACT Unhealthy alcohol use has increased significantly among aging women, raising their risk of serious alcohol related adverse consequences. At the same time, they are less likely than men to access treatment, and this is exacerbated among racial/ethnic minority women. Health care providers and systems will face an increasing number of aging women with alcohol problems, often with co-occurring health conditions that would improve with reduced drinking. Currently, there is limited research on the growing needs of this aging population, including on how racial/ethnic minority women may be disproportionately impacted by unhealthy alcohol use and on how to develop effective interventions. To understand these critical gaps and inform a holistic approach to alcohol-related healthcare, we propose a mixed-method study of over one million (1,298,009) aging women (≥age 50) in a diverse health care delivery system of over 4.5 million members. We leverage unique longitudinal electronic health record (EHR) data from a universal alcohol screening program in primary care, with an estimated 784,794 aging women regularly screened for unhealthy alcohol use at multiple primary care visits between 2014-2022. We integrate screening data with a NIAAA-funded alcohol registry that contains medical and psychiatric diagnoses, self-report health behaviors (e.g. tobacco, exercise, interpersonal violence screening), and health service encounters across clinical settings. Our approach is guided by a conceptual model that incorporates Intersectionality Theory and the Andersen’s Model of Health Services Utilization. We first identify trends and predictors of unhealthy alcohol use (defined as exceeding guidelines or alcohol use disorder) among aging women overall and by age and race/ethnicity. Second, we test whether health services utilization (e.g., routine primary care visits, brief alcohol interventions, medications, and addiction and/or psychiatry treatment) is associated with reductions in alcohol use over time among all aging women who report unhealthy alcohol use and among subsets with co-occurring health conditions (e.g., chronic pain, depression/anxiety, diabetes and hypertension) and medication use (e.g., opioids). Across each aim, we examine racial/ethnic differences to identify potential disparities. We use advanced causal modeling approaches to analyze hypothesized relationships, and to appropriately control for potential confounding and biases. For a deeper understanding of these vulnerable patients’ needs and potential barriers to care, we conduct qualitative interviews with aging women who report unhealthy alcohol use and with providers who care for them in different medical settings (e.g. primary care, geriatrics, addiction medicine), which we triangulate with the quantitative data. Findings will provide urgently needed evidence on how health services can impact unhealthy alcohol use, so that health care systems can better identify and treat this vulnerable population through targeted interventions.

抽象的老年女性不健康饮酒的情况显着增加，增加了她们严重酗酒的风险相关的不良后果。与此同时，她们获得治疗的可能性低于男性，这是少数种族/族裔妇女的情况更为严重。医疗保健提供者和系统将面临越来越多的有酗酒问题的老年妇女的数量，通常同时出现的健康状况会得到改善减少饮酒。目前，对人口老龄化不断增长的需求的研究有限，包括种族/族裔少数妇女可能如何受到不健康饮酒的不成比例的影响以及如何制定有效的干预措施。了解这些关键差距并提供整体方法对于与酒精相关的医疗保健，我们建议对超过 100 万 (1,298,009) 名老年女性进行混合方法研究（≥ 50 岁）在拥有超过 450 万成员的多元化医疗保健服务系统中。我们利用独特的来自初级保健通用酒精筛查计划的纵向电子健康记录 (EHR) 数据，据估计，有 784,794 名老年妇女在多个初级保健机构定期接受不健康饮酒情况筛查 2014 年至 2022 年期间的访问。我们将筛查数据与 NIAAA 资助的酒精登记系统集成，其中包含医学和精神诊断、自我报告的健康行为（例如烟草、运动、人际暴力）筛查），以及跨临床环境的卫生服务遭遇。我们的方法以概念为指导该模型结合了交叉理论和安徒生卫生服务利用模型。我们首先确定不健康饮酒的趋势和预测因素（定义为超出指导方针或饮酒总体上以及按年龄和种族/民族划分的老年女性中的疾病）。其次，我们测试是否有卫生服务利用（例如，常规初级保健就诊、简短的酒精干预、药物治疗和成瘾和/或精神病学治疗）与所有报告的老年女性随着时间的推移饮酒量的减少有关不健康的饮酒以及同时存在健康状况的子集（例如慢性疼痛、抑郁/焦虑、糖尿病和高血压）和药物使用（例如阿片类药物）。在每一个目标中，我们检查种族/民族差异以确定潜在的差异。我们使用先进的因果模型分析假设关系的方法，并适当控制潜在的混淆和偏见。为了更深入地了解这些弱势患者的需求和潜在的护理障碍，我们对报告不健康饮酒行为的老年妇女以及护理人员进行定性访谈为他们在不同的医疗环境（例如初级保健、老年病学、成瘾医学）中提供帮助，我们对此进行了三角测量与定量数据。研究结果将为卫生服务如何影响提供迫切需要的证据不健康的饮酒行为，以便医疗保健系统能够更好地识别和治疗这一弱势群体通过有针对性的干预。