Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.

{"article_title":"Multifaceted academic detailing program to increase pharmacotherapy for alcohol use disorder: interrupted time series evaluation of effectiveness.","author":"Harris AH, Bowe T, Hagedorn H, Nevedal A, Finlay AK, Gidwani R, Rosen C, Kay C, Christopher M","journal_title":"Addiction science & clinical practice","issn":"1940-0640","isbn":"","publication_date":"2016 Sep 15","volume":"11","issue":"1","first_page":"15","page_count":"","accession_number":"27633982","doi":"10.1186\/s13722-016-0063-8","publisher":"BioMed Central","doctype":"Journal Article","subjects":"Alcohol Deterrents administration & dosage; Alcohol-Related Disorders drug therapy; Patient Compliance statistics & numerical data; Veterans statistics & numerical data; Acamprosate; Adult; Alcohol-Related Disorders epidemiology; Disulfiram administration & dosage; Female; Fructose administration & dosage; Fructose analogs & derivatives; Humans; Male; Middle Aged; Naltrexone administration & dosage; Taurine administration & dosage; Taurine analogs & derivatives; Topiramate; United States; United States Department of Veterans Affairs; Young Adult","interest_area":["Internal\/Family Medicine"],"abstract":"Background: Active consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted academic detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites. Methods: An interrupted time series design, analyzed with mixed-effects segmented logistic regression, was used to evaluate changes in level and rate of change in the monthly percent of patients with a clinically documented AUD who received naltrexone, acamprosate, disulfiram, or topiramate. Using data from a 20 month post-implementation period, intervention sites (n = 37) were compared to their own 16 month pre-implementation performance and separately to the rest of VHA. Results: From immediately pre-intervention to the end of the observation period, the percent of patients in the intervention sites with AUD who received medication increased over 3.4 % in absolute terms and 68 % in relative terms (i.e., 4.9-8.3 %). This change was significant compared to the pre-implementation period in the intervention sites and secular trends in control sites. Sites with lower pre-implementation adoption, more person hours of detailing, but fewer people detailed, had larger immediate increases in medication receipt after implementation. The average number of detailing encounters per person was associated with steeper increases in slope over time. Conclusions: This study found empirical support for a multifaceted quality improvement strategy aimed at increasing access to and utilization of pharmacotherapy for AUD. Future studies should focus on determining how to enhance the programs effects, especially in non-responsive locations.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=27633982&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Harris AH, Bowe T, Hagedorn H, Nevedal A, Finlay AK, Gidwani R, Rosen C, Kay C, Christopher M","Journal_Info":"Publisher: BioMed Central Country of Publication: England NLM ID: 101316917 Publication Model: Electronic Cited Medium: Internet ISSN: 1940-0640 (Electronic) Linking ISSN: 19400632 NLM ISO Abbreviation: Addict Sci Clin Pract Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2016-09-15","Source":"Addiction science & clinical practice [Addict Sci Clin Pract] 2016 Sep 15; Vol. 11 (1), pp. 15. Date of Electronic Publication: 2016 Sep 15.","Languages":"English","Electronic_ISSN":"1940-0640","MeSH_Terms":"Alcohol Deterrents\/*administration & dosage , Alcohol-Related Disorders\/*drug therapy , Patient Compliance\/*statistics & numerical data , Veterans\/*statistics & numerical data, Acamprosate ; Adult ; Alcohol-Related Disorders\/epidemiology ; Disulfiram\/administration & dosage ; Female ; Fructose\/administration & dosage ; Fructose\/analogs & derivatives ; Humans ; Male ; Middle Aged ; Naltrexone\/administration & dosage ; Taurine\/administration & dosage ; Taurine\/analogs & derivatives ; Topiramate ; United States ; United States Department of Veterans Affairs ; Young Adult","Subjects":"Acamprosate, Adult, Alcohol-Related Disorders epidemiology, Disulfiram administration & dosage, Female, Fructose administration & dosage, Fructose analogs & derivatives, Humans, Male, Middle Aged, Naltrexone administration & dosage, Taurine administration & dosage, Taurine analogs & derivatives, Topiramate, United States, United States Department of Veterans Affairs, Young Adult, Alcohol Deterrents administration & dosage, Alcohol-Related Disorders drug therapy, Patient Compliance statistics & numerical data, Veterans statistics & numerical data","Title_Abbreviations":"Addiction science & clinical practice","Volume":"11"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"27633982","RelevancyScore":"795","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"795.40283203125"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=27633982&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=27633982&authtype=shib&custid=ns346513&group=main&profile=eds"}