Background:Effective medications for treating alcohol use disorders (AUD) are available but underutilized. Multiple\nbarriers to their provision have been identified, and optimal strategies for addressing and overcoming barriers to use\nof medications for AUD treatment remain elusive. We conducted a structured review of published care delivery and\nimplementation studies evaluating interventions that aimed to increase medication treatment for patients with AUD\nto identify interventions and component strategies that were most effective.\nMethods:We reviewed literature through May 2018 and used networking to identify intervention studies with AUD\nmedication receipt reported as a primary or secondary outcome. Studies were identified as care delivery studies,\ncharacterized by patient-level recruitment and willingness to be randomized to candidate treatment options, and\nimplementation studies, characterized by inclusion of all patients treated at sites involved in the study. Each identified\nstudy was independently coded by two investigators for strategies used, guided by a published taxonomy of\nimplementation strategies. All authors reviewed coding discrepancies and revised codes based on consensus. After\nreaching internal consensus, we solicited feedback from lead investigators on studies to code additional strategies.\nWe reviewed implementation strategies used across studies to assess their relationship with medication receipt, as\nwell as alcohol use outcomes, as available.\nResults:Nine studies were identified: four RCTs of care delivery interventions, four quasi-experimental evaluations of\nlarge-scale implementation interventions, and one quasi-experimental evaluation of a targeted single-site implementation\nintervention. Implementation strategies used were variable across studies; no strategy was universally used.\nEffects of the interventions on receipt of AUD pharmacotherapy and alcohol use outcomes also varied. Three of four\ncare delivery interventions resulted in increased receipt of AUD medications, but only one of these three improved\nalcohol use outcomes. One large-scale and one single-site implementation intervention were associated with\nincreased AUD medication receipt, and these studies did not assess alcohol use outcomes. Patterns of implementation\nstrategies did not clearly distinguish studies that successfully increased use of pharmacotherapy versus those\nthat did not.\nConclusions:Our review did not reveal strategies most effective for implementing AUD medications. Interventions\ndesigned to overcome identified barriers may have missed the mark, or differences in the intensity or targets of strategies\nmay matter more than differences in strategies. Further research is needed to understand effective implementation\nmethods and to better understand patient-level perspective, preferences and barriers to receipt of medications.
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