Medications for Alcohol Use Disorder:  Unfilled Prescriptions and Treatment Trajectories

项目总结：许多酒精使用障碍（AUD）患者没有接受治疗，包括 循证药物疗法。以前关于AUD药物使用的研究主要依赖于声称 数据，并因此仅关注AUD药物治疗过程的一部分（即，处方药）。 仅使用索赔数据，不可能区分没有收到索赔的个人的特征。 医生开的处方和那些收到处方但没有填写的人。这也是不可能理解的 药物处方和填充如何适应接受AUD治疗的轨迹。设计实践和 改善AUD药物使用的政策干预措施，临床医生和政策制定者需要了解 在治疗过程中的每一点都“掉下福尔斯”的人。我们建议使用一个大型国家的数据集， 2010年至2023年期间，保险公司的关联索赔和电子健康记录（EHR）数据，以及 在一项混合方法研究中，对AUD提供者进行了访谈。关联的数据将允许我们观察书面的 每个病人的处方，以及处方是否被填写。链接的数据还将 允许我们将临床相关信息纳入EHR中，而不是声明中。利用这些数据，我们 将：1）对于诊断为AUD的个人，确定与 开具AUD药物以及从索引AUD遭遇到处方的时间; 2）对于个人 诊断为AUD并开具AUD药物处方的患者，确定患者和处方者的特征 与填写处方和填写处方的时间相关;以及3）识别AUD护理的轨迹 其中包括为被诊断患有AUD的个人开具的处方信息，并检查 不同治疗轨迹与后续复发和损伤指标之间的相关性。的 研究的混合方法，包括对治疗AUD的供应商进行半结构化访谈， 影响他们的AUD药物处方决定的因素，将允许更细致的检查， AUD药物处方比单独定量分析允许的。这些发现将有助于确定 治疗过程不同类型的人从治疗中脱落，以及不同的治疗轨迹如何 与复发和损伤相关，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.