Prescription of topiramate to treat alcohol use disorders in the Veterans Health Administration

Addiction Science & Clinical Practice

ACDel Re⁴  Adam J Gordon²  Anna Lembke³  Alex HS Harris¹ 

[1] Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA 94025, USA

[2] VA Pittsburgh Healthcare System & University of Pittsburgh School of Medicine, 7180 Highland Drive (151 C-H), Pittsburgh, PA 15206-1206, USA

[3] Stanford Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA

[4] Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA

关键词: Veterans;    Pharmacotherapy utilization;    Topiramate;    Pharmacotherapy;    Addiction;    Alcohol use disorders;   

Others  :  789297
DOI  :  10.1186/1940-0640-8-12

 received in 2012-12-24, accepted in 2013-06-21,  发布年份 2013

【 摘 要 】

Background

As a quality improvement metric, the US Veterans Health Administration (VHA) monitors the proportion of patients with alcohol use disorders (AUD) who receive FDA approved medications for alcohol dependence (naltrexone, acamprosate, and disulfiram). Evidence supporting the off-label use of the antiepileptic medication topiramate to treat alcohol dependence may be as strong as these approved medications. However, little is known about the extent to which topiramate is used in clinical practice. The goal of this study was to describe and examine the overall use, facility-level variation in use, and patient -level predictors of topiramate prescription for patients with AUD in the VHA.

Methods

Using national VHA administrative data in a retrospective cohort study, we examined time trends in topiramate use from fiscal years (FY) 2009–2012, and predictors of topiramate prescription in 375,777 patients identified with AUD (ICD-9-CM codes 303.9x or 305.0x) treated in 141 VHA facilities in FY 2011.

Results

Among VHA patients with AUD, rates of topiramate prescription have increased from 0.99% in FY 2009 to 1.95% in FY 2012, although substantial variation across facilities exists. Predictors of topiramate prescription were female sex, young age, alcohol dependence diagnoses, engagement in both mental health and addiction specialty care, and psychiatric comorbidity.

Conclusions

Veterans Health Administration facilities are monitored regarding the extent to which patients with AUD are receiving FDA-approved pharmacotherapy. Not including topiramate in the metric, which is prescribed more often than acamprosate and disulfiram combined, may underestimate the extent to which VHA patients at specific facilities and overall are receiving pharmacotherapy for AUD.

【 授权许可】

   
2013 Del Re et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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