Medications for Alcohol Use Disorder:  Unfilled Prescriptions and Treatment Trajectories

项目概述：许多酒精使用障碍(AUD)患者得不到治疗，包括 循证药物疗法。以前关于澳大利亚的药物使用的研究主要依赖于声称 数据，因此只侧重于AUD药物治疗过程的一部分(即，填写的处方)。 仅使用索赔数据，不可能区分未收到索赔申请的个人的特征 临床医生开出的处方，由那些收到处方但没有配药的人开出。也不可能理解 药物处方和填充物如何适应接受AUD治疗的轨迹。设计实践和 将改善AUD药物使用的政策干预，临床医生和政策制定者需要了解 在治疗过程中的每一点上都会“掉下来”。我们建议使用一个大型国家的数据集 2010-2023年期间具有关联索赔和电子健康记录(EHR)数据的保险公司以及 在一项混合方法研究中，对AUD提供者进行了访谈。关联的数据将使我们能够观察到 每个病人的处方以及处方是否被填满。链接的数据还将 允许我们纳入EHR中可用的临床相关信息，但不包括索赔。使用这些数据，我们 将：1)对于被诊断为AUD的个人，确定与以下方面相关的患者和提供者特征 开出一种AUD药物以及从指数到遇到处方药的时间；2)个人 谁被诊断患有AUD，谁被开了AUD药物，确定患者和开药者的特征 与处方填写和处方填写时间相关联；以及3)识别AUD护理的轨迹 其中包括为被诊断为AUD的个人编写的处方信息，并检查 不同的治疗轨迹与随后复发和损伤的指标之间的关系。这个 研究的混合方法，包括对治疗AUD的提供者的半结构化访谈 影响他们AUD用药决定的因素，将允许更细微的检查 AUD药物处方超过了仅有定量分析所允许的范围。这些发现将有助于准确地确定 治疗过程不同类型的人退出治疗以及治疗轨迹有多大不同 与复发和伤害有关，为未来的干预和政策设计提供信息。

PROJECT SUMMARY: Many individuals with alcohol use disorder (AUD) receive no treatment, including evidence-based pharmacotherapies. Previous research on AUD medication use has primarily relied on claims data, and thus focuses on only a portion of the AUD medication treatment process (i.e., filled prescriptions). Using only claims data, it is not possible to distinguish the characteristics of individuals who do not receive a prescription from a clinician from those who receive one but do not fill it. It is also not possible to understand how medication prescriptions and fills fit into the trajectory of AUD treatment received. To design practice and policy interventions that will improve AUD medication use, clinicians and policy makers need to understand who “falls off” at each point in the treatment process. We propose to use a dataset from a large national insurer with linked claims and electronic health record (EHR) data for the period 2010-2023, as well as interviews of AUD providers, in a mixed methods study. The linked data will allow us to observe written prescriptions for each patient as well as whether or not the prescriptions were filled. The linked data will also allow us to incorporate clinically relevant information available in EHRs but not claims. Using these data, we will: 1) For individuals diagnosed with AUD, identify patient and provider characteristics associated with being prescribed an AUD medication and the time from index AUD encounter to prescription; 2) For individuals diagnosed with AUD who are prescribed an AUD medication, identify patient and prescriber characteristics associated with filling the prescription and with time to prescription fill; and 3) Identify trajectories of AUD care that incorporate information on prescriptions written for individuals diagnosed with AUD, and examine the association between different treatment trajectories and indicators of subsequent relapse and injury. The study's mixed methods approach, including semi-structured interviews of providers who treat AUD about the factors that influence their AUD medication prescribing decisions, will allow a more nuanced examination of AUD medication prescribing than quantitative analyses alone allow. The findings will help pinpoint where in the treatment process different types of people fall out of treatment and how different treatment trajectories are associated with relapse and injury, informing future intervention and policy design.