Abstract
Background and aims
Although evidence-based medications for alcohol use disorder (AUD) exist, they are alarmingly under-prescribed, particularly for United States (US) veterans. Only 9.5% of veterans who had an alcohol-related overdose death were prescribed a medication for alcohol use disorder (MAUD) in the year prior. Academic detailing (AD), an educational outreach targeting primary care providers (physicians, nurse practitioners and physician assistants), was implemented at the US Department of Veterans Affairs (VA) to improve MAUD prescribing rates among veterans with AUD. This study evaluated the effectiveness of AD outreach to VA primary care providers (PCPs) on MAUD prescribing rates among US veterans with AUD.
Design
We conducted a retrospective, quasi-experimental study using a staggered difference-in-differences approach to evaluate the difference in MAUD prescribing between VA PCPs who received and did not receive an AD outreach at VA between 1 January 2023 and 31 December 2023.
Setting
US Department of Veterans Affairs, the largest integrated national healthcare system in the United States.
Participants
A total of 5153 VA PCPs; 3436 (66.7%) physicians, 1385 (26.9%) nurse practitioners and 332 (6.4%) physician assistants.
Measurements
Clinician-level outpatient MAUD prescribing rates (number of prescriptions per 100 veterans with AUD), which included prescriptions of acamprosate, disulfiram, naltrexone and topiramate. Mean differences in MAUD prescribing rates between PCPs were reported alongside their 95% confidence interval (CI).
Findings
VA PCPs who received an AD encounter were associated with a statistically significant mean increase of 8.10 outpatient MAUD prescriptions per 100 veterans with AUD (95% CI = 5.20–11.01) compared with those who did not receive an AD encounter after adjusting for clinician-level characteristics. This was driven mainly by outpatient prescriptions of topiramate (+4.89; 95% CI = 3.18–6.60), naltrexone (+2.65; 95% CI = 0.90–4.40) and disulfiram (+0.43; 95% CI = 0.03–0.83). In the unadjusted model, there was a statistically significant increase in MAUD prescribing (+1.96; 95% CI = 0.25–3.68), but no statistically significant differences were reported for individual medications.
Conclusions
Between 01 January 2023 and 31 December 2023, primary care providers at the United States Department of Veterans Affairs who received academic detailing outreach were associated with increased medication for alcohol use disorder prescribing rates compared with those who did not receive academic detailing outreach. Academic detailing outreach appears to improve prescribing rates of medication for alcohol use disorder within the US Department of Veterans Affairs for veterans with alcohol use disorder, but careful adjustments of clinician-level characteristics are needed to mitigate potential bias.