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Article CommentaryAnnals Journal ClubA

Qualitative Investigation of Medication for Alcohol Use Disorder

Jonathan Yun and Michael E. Johansen
The Annals of Family Medicine July 2023, 21 (4) 384; DOI: https://doi.org/10.1370/afm.3008
Jonathan Yun
Grant Family Medicine
MD, MPH
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Michael E. Johansen
Grant Family Medicine
MD, MS
Roles: Associate Editor
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The Annals of Family Medicine encourages readers to develop a learning community to improve health and health care through enhanced primary care. With the Annals Journal Club, we encourage diverse participants—particularly among students, trainees, residents, and interns—to think critically about and discuss important issues affecting primary care, and even consider how their discussions might inform their practice.

HOW IT WORKS

The Annals provides discussion tips and questions related to one original research article in each issue. We welcome you to post a summary of your conversation to our eLetters section, a forum for readers to share their responses to Annals articles. Further information and links to previous Annals Journal Club features can be found on our website.

CURRENT SELECTION

Bhardwaj A, Sousa JL, Huskamp HA, et al. Prescribing medications for alcohol use disorder: a qualitative study of primary care physician decision making. Ann Fam Med. 2023;21(4):332-337.

Discussion Tips

Millions of Americans suffer from alcohol use disorder and primary care clinicians appear to underutilize medications for alcohol use disorder (MAUD). Beliefs about MAUD effectiveness, safety, and their effectiveness relative to non-medication therapies are potential barriers and facilitators to prescribing MAUD. The authors of this study interviewed physicians who had prescribed MAUD in the last 6 months to explore the reasons behind their decisions to prescribe or not prescribe MAUD.

Discussion Questions

  • What question is asked by this study and why does it matter?

  • How does this study advance beyond previous research and clinical practice on this topic?

  • How strong is the study design for answering the question?

  • What type of study is this (qualitative, quantitative, mixed methods, etc)?

  • Define codebook, saturation, and semistructured interviews

  • What is the theory of planned behavior? Is it a reasonable theory for what the authors are studying?

  • As discussed in the limitations section, how could using the theory of planned behavior as a theoretical framework lead to overfitting?

  • One way to measure the quality (or risk of bias) of a qualitative study is by examining its confirmability. What is confirmability and how did the authors address confirmability concerns?

  • What are criterion sampling and sampling for heterogeneity? How did the authors incorporate these sampling methods into their study design?

  • When you examine Table 1, are there other participant characteristics that would help you determine this study’s transferability to other settings?

  • What are the main study findings?

    • ◦ How do you think previous research about MAUD efficacy1 influences clinician attitudes about prescribing MAUD?

  • What are rules of thumb? How might they positively or negatively impact care?

  • What is your judgment about the transportability of the findings?

  • What contextual factors are important for interpreting this study’s findings?

  • How might this study change your practice? Policy? Education? Research?

  • Who is the intended audience for this study, and how might they be engaged in interpreting or using the findings?

  • What are the next steps in interpreting or applying this study’s findings?

  • © 2023 Annals of Family Medicine, Inc.

References

  1. 1.↵
    1. Jonas DE,
    2. Amick HR,
    3. Feltner C, et al.
    Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889–1900. doi:10.1001/jama.2014.3628
    OpenUrlCrossRefPubMed
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The Annals of Family Medicine: 21 (4)
The Annals of Family Medicine: 21 (4)
Vol. 21, Issue 4
July/August 2023
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Qualitative Investigation of Medication for Alcohol Use Disorder
Jonathan Yun, Michael E. Johansen
The Annals of Family Medicine Jul 2023, 21 (4) 384; DOI: 10.1370/afm.3008

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Qualitative Investigation of Medication for Alcohol Use Disorder
Jonathan Yun, Michael E. Johansen
The Annals of Family Medicine Jul 2023, 21 (4) 384; DOI: 10.1370/afm.3008
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