Integrating Treatments for Alcohol Use Disorder into Hepatology Clinics

将酒精使用障碍的治疗纳入肝病诊所

• 批准号: 10785211
• 负责人: Lamia Haque
• 金额: $ 19.42万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-13 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10785211
• 关键词: Adoption; Affect; Alcohol consumption; Alcoholic Liver Diseases; Alcohols; Area; Attitude; Behavior Therapy; Board Certification; Caring; Cessation of life; Cicatrix; Cirrhosis; Clinic; Clinical; Clinical Trials; Counseling; Coupled; Data; Dedications; Deterioration; Development; Drug Prescriptions; Effectiveness; Familiarity; Foundations; Future; Goals; Guidelines; Health Professional; Health Services Research; Hepatic; Hepatology; Intervention; Interview; Laboratories; Lead; Liver; Liver diseases; Medical; Medicine; Mentors; Methodology; Methods; Modeling; National Institute on Alcohol Abuse and Alcoholism; Outcome; Patient Care; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Pharmacoepidemiology; Pharmacy facility; Pilot Projects; Population; Positioning Attribute; Questionnaires; Readiness; Recommendation; Research; Research Methodology; Research Personnel; Research Training; Resources; Severity of illness; Specialist; Surveys; Testing; Training; Treatment Efficacy; United States; Veterans Health Administration; Work; acceptability and feasibility; addiction; alcohol abuse therapy; alcohol availability; alcohol consequences; alcohol screening; alcohol use disorder; clinical decision support; cohort; comparative effectiveness; cost effective; effectiveness/implementation trial; evidence base; feasibility testing; implementation facilitation; implementation intervention; implementation science; implementation strategy; improved; improved outcome; integrated care; interest; liver function; liver transplantation; multidisciplinary; novel; patient oriented; patient-level barriers; pilot test; preference; recruit; routine care; social stigma; system-level barriers; tertiary care; uptake; user-friendly

ABSTRACT Deaths due to alcohol-associated liver disease (ALD), a serious consequence of alcohol use disorder (AUD), have risen substantially over the past two decades. Although reduction and cessation of alcohol use is a vital component of treating ALD, few patients with AUD and ALD receive treatment for AUD, including behavioral treatment or medications (MAUD), due to clinician, patient, and system-level barriers ranging from lack of familiarity to stigma. Treatment of AUD, including MAUD, is associated with liver-specific benefits in patients with ALD, such as reductions in complications including cirrhosis, or scarring of the liver, and hepatic decompensation, or severe deterioration of liver function. As such, guidelines on the treatment of ALD recommend AUD treatment be provided to patients with AUD and ALD, however little is known regarding which treatments may be of greatest benefit in this population and how to deliver them most effectively. There is a lack of data regarding the comparative effectiveness of different forms of MAUD among patients with AUD and ALD and limited consideration of the perspectives of patients with AUD and ALD with regard to receipt of AUD treatment. Finally, while multidisciplinary teams of co-located hepatology and addiction specialists to facilitate AUD treatment in patients with AUD and ALD have been described, these models of care are resource- intensive and not commonly available. Therefore, alternative strategies are needed to inform delivery of AUD treatment for patients with both AUD and ALD. Hepatology clinicians are well-positioned to provide integrated AUD treatment, such as MAUD and brief counseling, for patients with AUD and ALD in the context of routine hepatology care. Existing NIAAA resources, such as the Healthcare Professional’s Core Resource on Alcohol (HPCR) and Alcohol Treatment Navigator (ATN), are readily available but have not been tailored for implementation in hepatology clinics. Therefore, the Specific Aims of this work are to: 1) Determine the comparative effectiveness of different forms of MAUD among patients with AUD by liver disease severity, relative to no MAUD, 2) Elicit AUD treatment preferences among patients with AUD and ALD, particularly regarding integrated MAUD and brief counseling in hepatology clinics, and 3) Determine the feasibility and acceptability of a novel implementation intervention to promote MAUD and brief counseling in hepatology clinics using the HPCR and ATN with clinical decision support. As a board-certified hepatologist and addiction medicine specialist with training in health services research, I am well-suited to lead efforts to integrate AUD treatment into hepatology clinics. Guided by mentors with expertise in pharmacoepidemiology, mixed-methods research, clinical trials, and implementation science, this work will generate important foundational data and provide me with the opportunity to build methodological expertise in these complementary areas. This will be critical to achieve my goal of becoming an independent clinician-investigator dedicated to optimizing the care of patients with AUD and ALD.

摘要 酒精相关性肝病（ALD）是酒精使用障碍（AUD）的严重后果， 在过去的二十年里大幅上升。虽然减少和停止饮酒是至关重要的 作为治疗ALD的组成部分，很少有AUD和ALD患者接受AUD治疗，包括行为治疗， 治疗或药物（MAUD），由于临床医生，患者和系统水平的障碍，从缺乏 熟悉耻辱。AUD治疗（包括MAUD）与患者的肝脏特异性获益相关 与ALD，如减少并发症，包括肝硬化，或疤痕的肝脏，和肝 失代偿或肝功能严重恶化。因此，关于ALD治疗的指南 建议向患有AUD和ALD的患者提供AUD治疗，但关于哪些治疗方法知之甚少。 治疗可能对这一人群最有益，以及如何最有效地提供治疗。有一个 缺乏关于不同形式的MAUD在AUD患者中的比较有效性的数据， ALD和对AUD和ALD患者接受AUD的观点的有限考虑 治疗最后，虽然多学科团队的共同定位肝病和成瘾专家，以促进 已经描述了AUD和ALD患者的AUD治疗，这些护理模式是资源- 密集的和不常见的。因此，需要替代策略来通知澳元的交付 治疗患有AUD和ALD的患者。肝病临床医生有能力提供综合的 在常规治疗的背景下，对AUD和ALD患者进行AUD治疗，如MAUD和简短咨询 肝病护理。现有的NIAAA资源，如医疗保健专业人员的酒精核心资源 （HPCR）和酒精治疗导航仪（ATN），是现成的，但还没有量身定制， 在肝病诊所实施。因此，本工作的具体目标是：1）确定 根据肝病严重程度比较不同形式的MAUD在AUD患者中的有效性， 相对于无MAUD，2）在AUD和ALD患者中诱导AUD治疗偏好，特别是 关于肝病诊所的综合MAUD和简短咨询，以及3）确定可行性， 肝病学中促进MAUD和简短咨询的新实施干预的可接受性 使用HPCR和ATN的诊所，并提供临床决策支持。作为一个有资格认证的肝病专家 作为一名受过卫生服务研究培训的医学专家，我非常适合领导将AUD 治疗进入肝病诊所。由具有药物流行病学专业知识的导师指导，混合方法 研究，临床试验和实施科学，这项工作将产生重要的基础数据， 为我提供了在这些互补领域建立方法专门知识的机会。这将是 关键是实现我的目标，成为一个独立的临床研究人员，致力于优化护理 与ALD和AUD患者。