Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada.
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...
| Published in: | Addiction Vol. 118; no. 11; pp. 2128 - 2139 |
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| Main Authors: | , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Nov2023
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=173385896&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 173385896 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09652140 AIO jtl: Addiction issn: 09652140 maglogo: Y pubinfo: dt: Nov2023 vid: 118 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 173385896 165765468 173385896 173385896 10.1111/add.16273 173385896 ppf: 2128 ppct: 11 formats: fmt: @attributes: type: P tig: atl: Using a cascade of care framework to identify gaps in access to medications for alcohol use disorder in British Columbia, Canada. aug: au: Socias, Maria Eugenia Xavier Scheuermeyer, Frank Zizhan Cui Wing Yin Mok Crabtree, Alexis Fairbairn, Nadia Nolan, Seonaid Slaunwhite, Amanda Lianping Ti affil: British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada sug: subj: Alcoholism Epidemiology Conceptual Framework Health Services Accessibility Patient Care Alcoholism Drug Therapy Alcohol Deterrents Therapeutic Use Alcoholism Complications Adverse Health Care Event Risk Factors Risk Assessment Human Male Female British Columbia Prospective Studies Retrospective Design Random Sample Descriptive Statistics Comparative Studies Odds Ratio Confidence Intervals Male Female ab: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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