Patient‐ and provider‐level factors that underlie alcohol use disorder treatment offer and acceptance in veterans with cirrhosis. (28th March 2022)

• Record Type: Journal Article
• Authors: Chaudhari, Rahul B.; Duong, Nikki; Shrestha, Shreesh; Badal, Bryan; Dharia, Neerav; Robalino Gonzaga, Ernesto; Spoutz, Patrick; Chia, Linda; Wade, James B.; Rogal, Shari; Bajaj, Jasmohan S.
• Is Part Of: Alcoholism. Volume 46:Number 5(2022)
• Page Start: 809
• Page End: 814
• Publication Date: 2022-03-28
• Subjects: alcohol use disorder -- alcohol‐associated liver disease -- patient factors -- provider factors -- veterans; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.14809
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract: Background: Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration. Methods: Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1‐year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ‐2) from the electronic health record. Results: The cohort included 654 veterans, 68 of whom were engaged in AUD treatment at baseline and 174 who were documented as being in AUD remission. Treatment was offered to 264 (64%) of the 412 veterans with opportunities to initiate it. AUD treatment discussions were most often documented by practitioners in primary care ( n = 162), hepatology ( n = 45), or both ( n = 41). Multivariable logistic regression modeling revealed that treatment was significantly more likely to be offered to patients with co‐occurring bipolar disorder (OR 2.94, p = 0.03) or depression (1.50, p = 0.05) or who were younger (0.97, p = 0.01). Of the 264 patients offered AUD treatment, 107 (40%) agreed to initiate it. Acceptance of an offer of treatment was significantly associated with hospitalization in the prior year (OR 1.74, p = 0.05), prior AUD treatment (9.92, p < 0.0001), and a higher PHQ‐2 depression score (2.85, p = 0.004). Conclusions: We identified factors associated with an offer of AUD treatment and its initiation among veterans with cirrhosis. Application of these findings could increase the likelihood that veterans with alcoholic cirrhosis initiate AUD treatment. Abstract : Patient and provider factors affecting alcohol use disorder (AUD) treatment offer and acceptance in cirrhosis are unclear. In this multi‐center analysis of 654 Veterans, 412 were not on AUD treatment or in remission, of whom 64% ( N = 264) were offered treatment. Alcohol use disorder treatment was mostly offered by primary care, more often to younger patients with bipolar disorder or depression. Forty percent accepted, who were more likely to have prior hospitalization, AUD treatment and depression. Understanding AUD treatment engagement barriers could improve acceptance.