Inpatient adoption of medications for alcohol use disorder: A mixed-methods formative evaluation involving key stakeholders

Paul J Joudrey; Benjamin J Oldfield; Kimberly A Yonkers; Patrick G O'Connor; Gretchen Berland; E Jennifer Edelman

doi:10.1016/j.drugalcdep.2020.108090

Inpatient adoption of medications for alcohol use disorder: A mixed-methods formative evaluation involving key stakeholders

Drug Alcohol Depend. 2020 Aug 1:213:108090. doi: 10.1016/j.drugalcdep.2020.108090. Epub 2020 Jun 2.

Authors

Paul J Joudrey¹, Benjamin J Oldfield², Kimberly A Yonkers³, Patrick G O'Connor², Gretchen Berland², E Jennifer Edelman²

Affiliations

¹ VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Ave, West Haven, CT, 06516, United States; Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, United States. Electronic address: [email protected].
² Department of Internal Medicine, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, United States.
³ Department of Psychiatry, Yale School of Medicine, 40 Temple Street, Ste Suite 6B, New Haven, CT, 06510, United States.

Abstract

Background: Although the inpatient setting presents an important opportunity for medications for alcohol use disorder (MAUD) adoption, this infrequently occurs. We aimed to develop a comprehensive understanding of barriers and facilitators of inpatient MAUD adoption.

Methods: A convergent mixed-method study conducted from April to September 2018 of non-prescribing (registered nurse, pharmacist, and social work) and prescribing (physician or advanced practice provider hospitalist, general internist, and psychiatrist) professionals at a large urban academic medical center. Survey assessed organizational readiness to adopt MAUD and focus groups guided by the Consolidated Framework for Implementation Research (CFIR) analyzed using directed content analysis.

Results: Fifty-seven participants completed surveys and one of seven focus groups. Health professionals perceived clinical evidence (mean 4.0, 95 % confidence interval [CI]: 3.9, 4.2) as supportive and patient preferences (mean 3.4, 95 % CI: 3.2, 3.6) and availability of resources (mean 3.1, 95 % CI: 2.8, 3.3) as less supportive of MAUD adoption. Stakeholders identified barriers across CFIR constructs; 1) Intervention characteristics: limited knowledge of MAUD effectiveness and concerns about side effects, 2) Outer setting: perceived patient vulnerability to care interruptions and a lack of external incentives, 3) Inner setting: a lack of organizational prioritization, and 4) Characteristics of individuals: stigma of people with AUD. Facilitators included: 1) Intervention characteristics: adaptation of workflows and 2) Characteristics of individuals: harm reduction as treatment goal.

Conclusions: This study identified multiple intersecting barriers and facilitators of inpatient MAUD adoption. Implementation interventions should prioritize strategies that increase health professional knowledge of MAUD and organizational prioritization of treating AUD.

Keywords: Alcohol use disorder; Implementation; Pharmacotherapy.

Abstract

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