Implementation Research for Evidence-based Care for Alcohol Dependence

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DESCRIPTION (provided by applicant): BACKGROUND. Emily Williams, PhD, MPH is a Core Investigator at VA Puget Sound HSR&D and an Assistant Professor in Health Services at the University of Washington. Dr. Williams has demonstrated a commitment to conducting VA research focused on improving access to and quality of care for Veterans with alcohol misuse. The proposed career development award will ensure that Dr. Williams will develop the skills and expertise necessary to become an independent health services researcher dedicated to improving care for Veterans with addictive disorders. CAREER DEVELOPMENT PLAN. The proposed CDA is focused on addressing one addictive disorder- alcohol dependence-which is common and undertreated among Veterans. While the standard of care is to offer patients with alcohol dependence referral to special specialty addictions treatment, most do not go. Therefore, experts agree that care for alcohol dependence should be expanded to primary care settings. While many of the behavioral treatments that are offered in specialty settings cannot reasonably be delivered in primary care, three medications are FDA-approved for treating alcohol dependence and can be prescribed in primary care. Thus, availability of these medications is recommended by VA guidelines, and optimizing their use is described as a goal in the VHA Handbook on Uniform Mental Health Services and the Substance Use Disorders QUERI Strategic Plan. However, most Veterans with alcohol dependence (~95%) do not receive them, and there are likely many barriers to primary care providers' prescribing them. The proposed CDA research aims to: 1) describe barriers and facilitators to VA primary care providers' treating alcohol dependence; 2) develop and pre-test an intervention to prepare primary care providers to treat alcohol dependence in VA primary care; and 3) test whether the intervention-disseminated in the context of other systems-level supports for management of alcohol dependence-is effective for increasing prescriptions for alcohol dependence medications at a single VA facility. The intervention will be developed based on state-of- the-art social marketing methods and informed by other behavior change theories. The planned research uses one-on-one qualitative interviews, focus groups, electronic surveys, and advanced interrupted time series design applied to secondary VA clinical and administrative data. The experience Dr. Williams will gain conducting the proposed research will be supplemented with structured training in alcohol dependence and behavior change theory, as well as implementation science, advanced methods, study design, and grant writing. Dr. Williams will conduct the research and training under the mentorship of experts at the forefront of VA implementation research on addictions (Katharine Bradley, MD, MPH; Alex Sox-Harris, PhD), biostatistical and qualitative methods (Andrew Zhou, PhD and Geoff Curran, PhD, respectively), use of medications to treat alcohol dependence in the VA (David Oslin, MD, MPH), behavioral interventions (Evette Ludman, PhD) and social marketing (Michael Siegel, MD, MPH and Mark Forehand, PhD). IMPACT. This CDA will allow Dr. Williams to collaborate with leaders in the VA to conduct research aimed at an important and measureable gap in high-quality care for alcohol dependence. Further, it will provide structured training and mentorship in implementation science and advanced methods for analyzing implementation research. Together these experiences will ensure Dr. Williams's successful transition to becoming an independent health services researcher whose career will improve the care of Veterans with addictive disorders.