Integration of pharmacotherapy for alcohol use disorder treatment in primary care settings: A scoping review

被引:4
作者
Hyland, Colby J. [1 ,6 ]
McDowell, Michal J. [2 ]
Bain, Paul A. [3 ]
Huskamp, Haiden A. [4 ]
Busch, Alisa B. [4 ,5 ]
机构
[1] Harvard Med Sch, 25 Shattuck St, Boston, MA 02115 USA
[2] Massachusetts Gen Hosp, Dept Psychiat, 15 Parkman St, Boston, MA 02114 USA
[3] Harvard Med Sch, Countway Lib Med, 10 Shattuck St, Boston, MA 02115 USA
[4] Harvard Med Sch, Dept Hlth Care Policy, 180 Longwood Ave, Boston, MA 02115 USA
[5] Harvard Med Sch, McLean Hosp, 115 Mill St, Belmont, MA 02478 USA
[6] 75 Francis St, Boston, MA 02115 USA
关键词
Alcohol use disorder; Primary care; Integrated care; Pharmacotherapy; Naltrexone; SUBSTANCE-ABUSE TREATMENT; CHRONIC DISEASE MANAGEMENT; BEHAVIORAL HEALTH-CARE; MENTAL-HEALTH; BRIEF INTERVENTION; TREATMENT ENGAGEMENT; TREATMENT INITIATION; ADDICTION TREATMENT; COLLABORATIVE CARE; TREATMENT PROGRAM;
D O I
10.1016/j.jsat.2022.108919
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Background: Alcohol use disorder (AUD) represents the most prevalent addiction in the United States. Integration of AUD treatment in primary care settings would expand care access. The objective of this scoping review is to examine models of AUD treatment in primary care that include pharmacotherapy (acamprosate, disulfiram, naltrexone). Methods: The team undertook a search across MEDLINE, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science on May 21, 2021. Eligibility criteria included: patient population >= 18 years old, primary care-based setting, US-based study, presence of an intervention to promote AUD treatment, and prescription of FDA-approved AUD pharmacotherapy. Study design was limited to controlled trials and observational studies. We assessed study bias using a modified Oxford Centre for Evidence-based Medicine Rating Framework quality rating scheme. Results: The qualitative synthesis included forty-seven papers, representing 25 primary studies. Primary study sample sizes ranged from 24 to 830,825 participants and many (44 %) were randomized controlled trials. Most studies (80 %) included a nonpharmacologic intervention for AUD: 56 % with brief intervention, 40 % with motivational interviewing, and 12 % with motivational enhancement therapy. A plurality of studies (48 %) included mixed pharmacologic interventions, with administration of any combination of naltrexone, acampro-sate, and/or disulfiram. Of the 47 total studies included, 68 % assessed care initiation and engagement. Fewer studies (15 %) explored practices surrounding screening for or diagnosing AUD. Outcome measures included receipt of pharmacotherapy and alcohol consumption, which about half of studies included (53 % and 51 %, respectively). Many of these outcomes showed significant findings in favor of integrated care models for AUD. Conclusions: The integration of AUD pharmacotherapy in primary care settings may be associated with improved process and outcome measures of care. Future research should seek to understand the varied experiences across care integration models.
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页数:11
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