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J Gen Intern Med. 2018 Mar;33(3):258-267. doi: 10.1007/s11606-017-4202-z. Epub 2017 Oct 30.

Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics.

Author information

1
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA. emily.williams3@va.gov.
2
Department of Health Services, University of Washington, Seattle, WA, USA. emily.williams3@va.gov.
3
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
4
General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System - Seattle Division, Seattle, WA, USA.
5
Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System - Seattle Division, Seattle, WA, USA.
6
Department of Medicine, University of Washington, Seattle, WA, USA.
7
Central Arkansas Veterans Health Care System, Little Rock, AR, USA.
8
Department of Health Services, University of Washington, Seattle, WA, USA.
9
Department of Community Health Sciences, Boston University School of Public Heath, Boston, MA, USA.
10
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
11
Foster School of Business, University of Washington, Seattle, WA, USA.
12
Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.

Abstract

BACKGROUND:

Three medications are FDA-approved and recommended for treating alcohol use disorders (AUD) but they are not offered to most patients with AUD. Primary care (PC) may be an optimal setting in which to offer and prescribe AUD medications, but multiple barriers are likely.

OBJECTIVE:

This qualitative study used social marketing theory, a behavior change approach that employs business marketing techniques including "segmenting the market," to describe (1) barriers and facilitators to prescribing AUD medications in PC, and (2) beliefs of PC providers after they were segmented into groups more and less willing to prescribe AUD medications.

DESIGN:

Qualitative, interview-based study.

PARTICIPANTS:

Twenty-four providers from five VA PC clinics.

APPROACH:

Providers completed in-person semi-structured interviews, which were recorded, transcribed, and analyzed using social marketing theory and thematic analysis. Providers were divided into two groups based on consensus review.

KEY RESULTS:

Barriers included lack of knowledge and experience, beliefs that medications cannot replace specialty addiction treatment, and alcohol-related stigma. Facilitators included training, support for prescribing, and behavioral staff to support follow-up. Providers more willing to prescribe viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective "tool" or "foot in the door" for treating AUD, and believed that providing AUD medications in PC might catalyze change while reducing stigma and addressing other barriers to specialty treatment. Those less willing believed that medications could not effectively treat AUD, and that treating AUD was the role of specialty addiction treatment providers, not PC providers, and would require time and expertise they do not have.

CONCLUSIONS:

We identified barriers to and facilitators of prescribing AUD medications in PC, which, if addressed and/or capitalized on, may increase provision of AUD medications. Providers more willing to prescribe may be the optimal target of a customized implementation intervention to promote changes in prescribing.

KEYWORDS:

alcohol use disorders; barriers; facilitators; medication-assisted treatment; pharmacotherapy; social marketing

PMID:
29086341
PMCID:
PMC5834954
[Available on 2019-03-01]
DOI:
10.1007/s11606-017-4202-z

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