Category: Federal Forum Posters
Purpose: Alcohol use disorder (AUD) is a common disease among veterans that often goes untreated. Pharmacists are in a unique role to offer first line pharmacotherapy to veterans for management of AUD. This quality improvement project evaluated the impact of clinical pharmacist directed treatment of AUD. The primary objective was to measure effect on alcohol consumption frequency and quantity in veterans enrolled in the AUD clinic. A secondary objective examined patient access to AUD pharmacotherapy by comparing the number of patients who recalled being offered an AUD medication prior to clinic versus those that did not.
Methods: This project was approved by the Pharmacy and Therapeutics (P&T) Committee prior to implementation and did not require IRB approval. The VA Academic Detailing Service (ADS) Alcohol Use Disorder Data Resource was used to identify patients with AUD who were not receiving drug therapy for treatment of AUD and had an Alcohol Use Disorder Identification Test (AUDIT-C) score of 4-9 recorded in 2017. Patients were excluded from entry into clinic if they had an active prescription for AUD pharmacotherapy, AUD in remission, primary care or mental health provider outside the VA, an AUDIT-C score of greater than 9 or less than or equal to 3, hospitalization in the 6 months prior to clinic implementation for an unstable medical condition, recent or current substance use disorder programming, or a co-occurring substance use disorder (other than nicotine or cannabis). A pharmacist sent consults to primary care or mental health providers for enrollment. Once enrolled, alcohol consumption frequency and quantity was tracked using the Quick Drinking Screen (QDS) to evaluate days drinking per week, drinks per week, drinks/drinking day, and days per week drinking greater than or equal to 5 drinks per day. Patients were seen in clinic following the Addiction-Focused Medical Management format, and education was provided regarding pharmacotherapy. Data collection stopped after 4 months of clinic time and was analyzed using descriptive and inferential statistics.
Results: A total of 50 patients met criteria for entry into clinic. Thirty-one patients were not enrolled in clinic as consultation was declined (25 patients declined and 6 providers declined). A total of 19 patients were enrolled into the AUD clinic. Of this number, 12 patients were seen once (discharged or lost to follow-up), and 7 patients were seen at least twice in clinic. The baseline average AUDIT-C score of patients seen in clinic was 5.6 representing moderate to high risk drinking. The majority of patients seen in clinic had a comorbid diagnosis of depression, a pain related condition, or nicotine use disorder. During the intervention window, days drinking per week was decreased from 5.42 to 5.19, drinks per week was decreased from 23.32 to 21.62, drinks per drinking day was decreased from 3.84 to 3.64, and days per week binge drinking was decreased from 3.05 to 2.28. Only 1 patient recalled being offered an AUD medication prior to clinic enrollment out of the 19 patients seen at least once in clinic. One patient was managed on follow-up using naltrexone therapy in addition to brief intervention, and 6 patients were managed on follow-up using brief intervention alone.
Conclusion: The pharmacy led AUD clinic decreased alcohol consumption frequency and quantity and increased patient education regarding AUD medications. Multiple areas for ongoing process improvement to optimize patient care were identified. Currently enrolled patients continue to be managed in clinic. Future plans for clinic expansion may include prospective enrollment of patients with positive AUDIT-C screens in primary care or mental health settings.
Christopher Wilson– Pharmacy Resident, Sheridan VA Medical Center, Sheridan, WY