Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-07-24 DOI:10.1111/add.16273

Maria Eugenia Socias, Frank Xavier Scheuermeyer, Zizhan Cui, Wing Yin Mok, Alexis Crabtree, Nadia Fairbairn, Seonaid Nolan, Amanda Slaunwhite, Lianping Ti

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引用次数: 1

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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使用级联护理框架来确定加拿大不列颠哥伦比亚省在获得酒精使用障碍药物方面的差距

背景和目的尽管酒精使用障碍（AUD）的负担很重，而且可以获得安全有效的治疗AUD的药物，但在人群水平上对获得和参与AUD相关护理的估计是有限的。本研究的目的是在加拿大不列颠哥伦比亚省（BC）为AUD提供一系列护理，并估计MAUD对健康结果的影响。设计这是一项基于人群的回顾性队列研究，使用相关的管理健康数据。设定加拿大不列颠哥伦比亚省，2015-2019年。参与者使用不列颠哥伦比亚省居民的20%随机样本，我们确定了7231名患有中度至重度酒精使用障碍（PWAUD；总体患病率=0.7%）的人。测量我们在PWAUD中建立了六阶段AUD级联（从诊断到MAUD滞留≥6个月）。我们评估了一段时间以来的趋势，并估计了MAUD对AUD相关住院、急诊就诊和死亡的影响。研究结果2015年至2019年间，与AUD相关护理的相关性降低（从80.4%降至46.5%）。然而，MAUD开始率（11.4%至24.1%）和≥1个月（7.0%至18.2%）、≥3个月（1.2%至4.3%）或≥6个月（0.2%至1.6%）的保留率显著增加。在调整后的分析中，使用MAUD与经历任何AUD相关不良结果的几率降低有关，MAUD的保留时间越长，几率降低的趋势越大：MAUD保留时间的调整后比值比（95%CI）范围为0.59（0.48-0.71）<；1个月至0.37（0.21–0.67），保留期≥6个月。结论2015年至2019年间，加拿大不列颠哥伦比亚省中度至重度酒精使用障碍患者获得治疗酒精使用障碍药物的机会增加；然而，引发和保留率仍然很低。有一种趋势是，酒精使用障碍药物的保留时间更长，与酒精使用障碍相关的不良后果的几率更大。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.