RT Journal Article
SR Electronic
T1 Prescribing Medications for Alcohol Use Disorder: A Qualitative Study of Primary Care Physician Decision Making
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 332
OP 337
DO 10.1370/afm.2997
VO 21
IS 4
A1 Bhardwaj, Anvita
A1 Sousa, Jessica L.
A1 Huskamp, Haiden A.
A1 Busch, Alisa B.
A1 Kennedy-Hendricks, Alene
A1 Hodgkin, Dominic
A1 Horgan, Constance
A1 Uscher-Pines, Lori
YR 2023
UL http://www.annfammed.org/content/21/4/332.abstract
AB PURPOSE Over 29 million Americans have alcohol use disorder (AUD). Though there are effective medications for AUD (MAUD) that can be prescribed within primary care, they are underutilized. We aimed to explore how primary care physicians familiar with MAUD make prescribing decisions and to identify reasons for underuse of MAUD within primary care.METHODS We conducted semistructured interviews with 19 primary care physicians recruited from a large online database of medical professionals. Physicians had to have started a patient on MAUD within the last 6 months in an outpatient setting. Inductive and deductive thematic analysis was informed by the theory of planned behavior.RESULTS Physicians endorsed that it is challenging to prescribe MAUD due to several reasons, including: (1) somewhat negative personal beliefs about medication effectiveness and likelihood of patient adherence; (2) competing demands in primary care that make MAUD a lower priority; and, (3) few positive subjective norms around prescribing. To make MAUD prescribing a smaller component of their practice, physicians reported applying various rules of thumb to select patients for MAUD. These included recommending MAUD to the patients who seemed the most motivated to reduce drinking, those with the most severe AUD, and those who were also receiving other treatments for AUD.CONCLUSIONS There is a challenging implementation context for MAUD due to competing demands within primary care. Future research should explore which strategies for identifying a subset of patients for MAUD are the most appropriate and most likely to improve population health and health equity.