Background: Primary care provider skills such as screening, longitudinal monitoring, and medication management\nare generalizable to prescribing alcohol use disorder (AUD) pharmacotherapy. The association between primary\ncare engagement (i.e., longitudinal utilization of primary care services) and prescribing of AUD pharmacotherapy is\nunknown.\nMethods: We examined a 5-year (2010-2014) retrospective cohort of patients with AUD, 18 years and older, at an\nurban academic medical center in the Bronx, NY, USA. Our main exposure was level of primary care engagement (no\nprimary care, limited primary care, and engaged with primary care) and our outcome was any AUD pharmacotherapy\nprescription within 2 years of AUD diagnosis. Using multivariable logistic regression, we examined the association\nbetween primary care engagement and pharmacotherapy prescribing, accounting for demographic and clinical\nfactors.\nResults: Of 21,159 adults (28.9% female) with AUD, 2.1% (n = 449) were prescribed pharmacotherapy. After adjusting\nfor confounders, the probability of receiving an AUD pharmacotherapy prescription for patients with no primary care\nwas 1.61% (95% CI 1.39, 1.84). The probability of AUD pharmacotherapy prescribing was 2.56% (95% CI 2.06, 3.06) for\npatients with limited primary care and 2.89% (95% CI 2.44, 3.34%) for patients engaged with primary care.\nConclusions: The percentage of AUD patients prescribed AUD pharmacotherapy was low; however, primary care\nengagement was associated with a higher, but modest, probability of receiving a prescription. Efforts to increase\nprimary care engagement among patients with AUD may translate into increased AUD pharmacotherapy prescribing;\nhowever, strategies to increase prescribing across health care settings are needed.
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