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Research article:
Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study
Reference:
Andrew Thompson, Darren M. Ashcroft, Lynn Owens, Tjeerd P. van Staa, Munir Pirmohamed(2017) Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study. PLoS ONE, doi:
- Link to article
- Abstract
- Aim To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care. Design Open cohort study. Setting General practices contributing data to the UK Clinical Practice Research Database. Participants 39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013. Main outcome measure Use of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence. Findings Only 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram. Conclusion Drug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.
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Code list: res58: case definition for alcohol dependence
39 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 8BA8.00 | Read | alcohol detoxification | diagnostic | res58: case definition for alcohol dependence | |||
| 8H35.00 | Read | admitted to alcohol detoxification centre | diagnostic | res58: case definition for alcohol dependence | |||
| E010.00 | Read | Alcohol withdrawal delirium | diagnostic | res58: case definition for alcohol dependence | |||
| E010.12 | Read | Delirium tremens | diagnostic | res58: case definition for alcohol dependence | |||
| E012000 | Read | Chronic alcoholic brain syndrome | diagnostic | res58: case definition for alcohol dependence | |||
| E013.00 | Read | Alcohol withdrawal hallucinosis | diagnostic | res58: case definition for alcohol dependence | |||
| E01y000 | Read | Alcohol withdrawal syndrome | diagnostic | res58: case definition for alcohol dependence | |||
| E23..00 | Read | Alcohol dependence syndrome | diagnostic | res58: case definition for alcohol dependence | |||
| E230.00 | Read | Acute alcoholic intoxication in alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E230000 | Read | Acute alcoholic intoxication, unspecified, in alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E230100 | Read | Continuous acute alcoholic intoxication in alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E230.11 | Read | Alcohol dependence with acute alcoholic intoxication | diagnostic | res58: case definition for alcohol dependence | |||
| E230300 | Read | Acute alcoholic intoxication in remission, in alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E230z00 | Read | Acute alcoholic intoxication in alcoholism NOS | diagnostic | res58: case definition for alcohol dependence | |||
| E231.00 | Read | Chronic alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E23..11 | Read | Alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E231100 | Read | Continuous chronic alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| E231.11 | Read | Dipsomania | diagnostic | res58: case definition for alcohol dependence | |||
| E231300 | Read | Chronic alcoholism in remission | diagnostic | res58: case definition for alcohol dependence | |||
| E231z00 | Read | Chronic alcoholism NOS | diagnostic | res58: case definition for alcohol dependence | |||
| E23z.00 | Read | Alcohol dependence syndrome NOS | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10200 | Read | [X]Mental and behavioural disorders due to use of alcohol: dependence syndrome | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10211 | Read | [X]Alcohol addiction | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10212 | Read | [X]Chronic alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10213 | Read | [X]Dipsomania | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10300 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10400 | Read | [X]Mental and behavioural disorders due to use of alcohol: withdrawal state with delirium | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10411 | Read | [X]Delirium tremens, alcohol induced | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10712 | Read | [X]Chronic alcoholic brain syndrome | diagnostic | res58: case definition for alcohol dependence | |||
| Eu10800 | Read | [X]Alcohol withdrawal-induced seizure | diagnostic | res58: case definition for alcohol dependence | |||
| F11x000 | Read | Cerebral degeneration due to alcoholism | diagnostic | res58: case definition for alcohol dependence | |||
| F11x011 | Read | Alcoholic encephalopathy | diagnostic | res58: case definition for alcohol dependence | |||
| F375.00 | Read | Alcoholic polyneuropathy | diagnostic | res58: case definition for alcohol dependence | |||
| F394100 | Read | Alcoholic myopathy | diagnostic | res58: case definition for alcohol dependence | |||
| G555.00 | Read | Alcoholic cardiomyopathy | diagnostic | res58: case definition for alcohol dependence | |||
| J612.00 | Read | Alcoholic cirrhosis of liver | diagnostic | res58: case definition for alcohol dependence | |||
| J617000 | Read | Chronic alcoholic hepatitis | diagnostic | res58: case definition for alcohol dependence | |||
| J671000 | Read | Alcohol-induced chronic pancreatitis | diagnostic | res58: case definition for alcohol dependence | |||
| Z191.00 | Read | alcohol detoxification | diagnostic | res58: case definition for alcohol dependence |
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