Diffusion, Adoption, and Implementation of Pharmacotherapies in Alcohol Tx

描述(申请人提供)：尽管最近在开发治疗酒精依赖的药物疗法方面取得了进展，但治疗界在采用和实施这些循证做法方面进展缓慢。这项拟议的研究通过检查FDA最近批准的三种治疗酒精依赖的药物疗法-纳曲酮、氨基己酸酯和Vivitrol的采用、推广和实施情况，解决了这一研究与实践之间的差距。这项研究的具体目的有三个：(1)描述、比较和对比纳曲酮、阿卡米松和维维特罗在成瘾治疗方案中的采用、传播和实施的趋势。(2)确定随时间推移促进或阻碍这三种药物疗法的传播、采用和实施的关键结构和劳动力特征。(3)详细说明、检验和比较预测三种药物疗法采用和实施的多变量模型的“适合性”。这项拟议研究的数据将来自国家治疗中心研究(NTCS)，这是一项具有全国代表性的纵向研究，涉及403个私人吸毒者成瘾治疗计划。目前和未来的NTCS数据收集为研究人员提供了机会，以检查Aamprosate和Vivitrol在日常治疗实践中的“实时”扩散，并与1994年获得FDA批准的纳曲酮进行总体扩散趋势比较。拟议的研究将通过测试作为组织和劳动力层面特征的产物的采纳和实施模式、测试关键组织和劳动力预测因素之间的相互作用以及利用多层次和纵向数据分析技术，对药物滥用健康服务领域作出重大贡献。这项研究的结果将提供有关组织和劳动力特征的重要信息，这些特征塑造了以研究为基础的医疗技术进入日常实践的过程，并提供了对采用和实施药物疗法的障碍的更多了解。这些信息将与治疗提供者、卫生研究人员和卫生政策制定者有关，因为他们正在寻求弥合“研究与实践的差距”，并改善酗酒患者获得高质量治疗的机会。

DESCRIPTION (provided by applicant): Despite recent advances in the development of pharmacotherapies for the treatment of alcohol dependence, the treatment community has been slow to adopt and implement these evidence-based practices. The proposed research addresses this research-to-practice gap by examining the adoption, diffusion, and implementation of the three most recent FDA approved pharmacotherapies for the treatment of alcohol dependence-naltrexone, acamprosate, and Vivitrol. The specific aims of the proposed research are threefold: (1) Describe, compare, and contrast trends in the adoption, diffusion and implementation of naltrexone, acamprosate.and Vivitrol by addiction treatment programs. (2) Identify key structural and workforce characteristics that facilitate or impede diffusion, adoption and implementation of these three pharmacotherapies over time. (3) Specify, test, and compare the "fit" of multivariate models predicting the adoption and implementation of the three pharmacotherapies. Data for the proposed research will be taken from the National Treatment Center Study (NTCS), a nationally representative, longitudinal study of 403 privatesector addiction treatment programs. Present and future NTCS data collections provide researchers the opportunity to examine the "real time" diffusion of acamprosate and Vivitrol into everyday treatment practice and to compare overall diffusion trends with naltrexone which received FDA approval in 1994. The proposed research will make significant contributions to the field of substance abuse health services by testing models of adoption and implementation as a product of both organizational and workforce level characteristics, testing for interactions between key organizational and workforce predictors, and utilizing multi-level and longitudinal data analysis techniques. The results of this research will provide important information about the organizational and workforce characteristics that shape the movement of research based medical technologies into everyday practice and provide a greater understanding of the barriers to adoption and implementation of pharmacotherapies. This information will be relevant to treatment providers, health researchers, and health policymakers as they seek to bridge the "research to practice gap" and improve access to quality treatment for persons suffering from alcoholism.