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Socias ME, Scheuermeyer FX, Cui Z, Mok WY, Crabtree A, Fairbairn N, Nolan S, Slaunwhite A, Ti L. Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada. Addiction 2023; 118:2128-2138. [PMID: 37488683 DOI: 10.1111/add.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 05/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND AND AIMS Despite the significant burden of alcohol use disorder (AUD) and availability of safe and effective medications for AUD (MAUD), population-level estimates of access and engagement in AUD-related care are limited. The aims of this study were to generate a cascade of care for AUD in British Columbia (BC), Canada, and to estimate the impacts of MAUD on health outcomes. DESIGN This was a retrospective population-based cohort study using linked administrative health data. SETTING British Columbia, Canada, 2015-2019. PARTICIPANTS Using a 20% random sample of BC residents, we identified 7231 people with moderate-to-severe alcohol use disorder (PWAUD; overall prevalence = 0.7%). MEASUREMENTS We developed a six-stage AUD cascade (from diagnosis to ≥6 months retention in MAUD) among PWAUD. We evaluated trends over time and estimated the impacts of access to MAUD on AUD-related hospitalizations, emergency department visits and death. FINDINGS Between 2015 and 2019, linkage to AUD-related care decreased (from 80.4% to 46.5%). However, rates of MAUD initiation (11.4% to 24.1%) and retention for ≥1 (7.0% to 18.2%), ≥3 (1.2% to 4.3%) or ≥6 months (0.2% to 1.6%) increased significantly. In adjusted analyses, access to MAUD was associated with reduced odds of experiencing any AUD-related adverse outcomes, with longer retention in MAUD showing a trend to greater odds reduction: adjusted odds ratio (95% CI) ranging from 0.59 (0.48-0.71) for MAUD retention <1 month to 0.37 (0.21-0.67) for ≥6 months retention. CONCLUSIONS Access to medications for alcohol use disorder among people with moderate-to-severe alcohol use disorder in British Colombia, Canada increased between 2015 and 2019; however, initiation and retention remained low. There was a trend between longer retention in medications for alcohol use disorder and greater reductions in the odds of experiencing alcohol use disorder-related adverse outcomes.
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Affiliation(s)
- Maria Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank Xavier Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zizhan Cui
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wing Yin Mok
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Alexis Crabtree
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Nadia Fairbairn
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Slaunwhite
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Witkiewitz K, Kranzler HR, Hallgren KA, O'Malley SS, Falk DE, Litten RZ, Hasin DS, Mann KF, Anton RF. Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 42:2453-2465. [PMID: 30395350 PMCID: PMC6286196 DOI: 10.1111/acer.13897] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abstinence and no heavy drinking days are currently the only Food and Drug Administration-approved end points in clinical trials for alcohol use disorder (AUD). Many individuals who fail to meet these criteria may substantially reduce their drinking during treatment, and most individuals with AUD prefer drinking reduction goals. One- and two-level reductions in World Health Organization (WHO) drinking risk levels have been proposed as alternative end points that reflect reduced drinking and are associated with reductions in drinking consequences, improvements in mental health, and reduced risk of developing alcohol dependence. The current study examined the association between WHO drinking risk level reductions and improvements in physical health and quality of life in a sample of individuals with alcohol dependence. METHODS Secondary data analysis of individuals with alcohol dependence (n = 1,142) enrolled in the longitudinal, prospective COMBINE study, a multi site randomized placebo-controlled clinical trial, examining the association between reductions in WHO drinking risk levels and change in blood pressure, liver enzyme levels, and self-reported quality of life following treatment for alcohol dependence. RESULTS One- and two-level reductions in WHO drinking risk level during treatment were associated with significant reductions in systolic blood pressure (p < 0.001), improvements in liver enzyme levels (all p < 0.01), and significantly better quality of life (p < 0.001). CONCLUSIONS One- and two-level reductions in WHO drinking risk levels predicted significant improvements in markers of physical health and quality of life, suggesting that the WHO drinking risk level reduction could be a meaningful surrogate marker of improvements in how a person "feels and functions" following treatment for alcohol dependence. The WHO drinking risk levels could be useful in medical practice for identifying drinking reduction targets that correspond with clinically significant improvements in health and quality of life.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology , University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences , University of Washington, Seattle, Washington
| | | | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Deborah S Hasin
- Department of Epidemiology , Columbia University, New York, New York
| | - Karl F Mann
- Medical Faculty Mannheim , Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina, Charleston, South Carolina
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Costa M, Marcellin F, Coste M, Barré T, Nordmann S, Mora M, Maradan G, Tanti M, Cutarella C, Casanova D, Levy-Bellaiche S, Polomeni P, Simon N, Roux P, Carrieri MP. Access to care for people with alcohol use disorder in France: a mixed-method cross-sectional study protocol (ASIA). BMJ Open 2018; 8:e024669. [PMID: 30269077 PMCID: PMC6169764 DOI: 10.1136/bmjopen-2018-024669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a major public health concern worldwide. In France, only 10% of people with AUD (PWAUD) receive medical care. General practitioners (GP) are one of the main entry points for AUD care. The present ongoing study, entitled ASIA (Access to Care and Indifference toward Alcohol, Accès aux Soins et Indifference à l'Alcool in French), aims to improve knowledge about factors associated with access to care for AUD by exploring related GP and PWAUD practices, experiences and perceptions. METHODS AND ANALYSIS The ASIA project is an ongoing cross-sectional multisite study based on a complementary mixed-method approach (quantitative and qualitative) using a convergent parallel design. The double-perspective design of the study will enable us to collect and compare data regarding both PWAUD and GP points of view. For the PWAUD quantitative study, 260 PWAUD will be interviewed using a telephone-based questionnaire. For the qualitative study, 36 PWAUD have already been interviewed. The GP quantitative study will include 100 GP in a 15 min survey. Fifteen GP have already participated in semistructured interviews for the qualitative study. Logistic regression will be used to identify predictors for access to care. With respect to data analyses, qualitative interviews will be analysed using semantic analysis while quantitative logistic regression will be used for quantitative interviews. ETHICS AND DISSEMINATION This study was approved by the CNIL (French National Commission on Informatics and Liberties) (approval reference number: C16-10, date of approval: 17 July 2017), the CCTIRS (Advisory Committee on Information Processing in Material Research in the Field of Health) and the CEEI (Evaluation and Ethics Committee) (approval reference number: 16-312, date of approval: 8 July 2016) of INSERM (French National Institute of Health and Medical Research). Results from ASIA will be disseminated in peer-reviewed publications, conference presentations, reports and in a PhD thesis.
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Affiliation(s)
- Marie Costa
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Fabienne Marcellin
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Coste
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Tangui Barré
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Sandra Nordmann
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Gwenaëlle Maradan
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Marc Tanti
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
- CESPA, Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
| | | | - Danielle Casanova
- CSAPA, Centre de soins, d’accompagnement et de prévention en addictologie, Arles, France
| | | | | | - Nicolas Simon
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Perrine Roux
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Maria-Patrizia Carrieri
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix-Marseille Université, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
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