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

Del Re AC, Gordon AJ, Lembke A, Harris AH - Addict Sci Clin Pract (2013)

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA 94025, USA. aaron.delre@va.gov

ABSTRACT

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.

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Related in: MedlinePlus

Percentage of patients in 141 facilities receiving topiramate in FY 2011 by receipt of specialty care. Displayed is the variability in facility level percentage of patients prescribed topiramate by specialty care services. The 141 VA facilities are ordered from smallest to largest percentage and the size of each point represents the number of patients within each respective specialty care service.
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Figure 1: Percentage of patients in 141 facilities receiving topiramate in FY 2011 by receipt of specialty care. Displayed is the variability in facility level percentage of patients prescribed topiramate by specialty care services. The 141 VA facilities are ordered from smallest to largest percentage and the size of each point represents the number of patients within each respective specialty care service.

Mentions: In the unadjusted single-predictor models, veteran patients with an AUD were more likely to fill a prescription for topiramate in FY 2011 if they were female, younger, had alcohol dependence, were involved in both mental health and addiction specialty care, and had a psychiatric comorbidity (Table 2). These results remained consistent in the adjusted multi-predictor analyses (Table 3). Specifically, patients were more likely to be prescribed topiramate if they were female (OR = 2.50; 95% confidence interval (CI), 2.31, 2.71), were between 30–55 years old compared with >55 (OR = 1.66; 95% CI, 1.56, 1.76), had alcohol dependence versus abuse (OR = 1.15; 95% CI, 1.08, 1.22), were involved in both mental health and addiction specialty care (OR = 3.75; 95% CI, 3.24, 4.43), and had a psychiatric comorbidity (depending on specific psychiatric diagnosis, estimates ranged from OR = 1.74; 95% CI, 1.43, 2.11 for schizophrenia to OR = 4.497; 95% CI, 4.07, 4.96 for other multiple psychiatric diagnoses). Figure 1 displays the facility prescription rates of topiramate by receipt of specialty care.


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

Del Re AC, Gordon AJ, Lembke A, Harris AH - Addict Sci Clin Pract (2013)

Percentage of patients in 141 facilities receiving topiramate in FY 2011 by receipt of specialty care. Displayed is the variability in facility level percentage of patients prescribed topiramate by specialty care services. The 141 VA facilities are ordered from smallest to largest percentage and the size of each point represents the number of patients within each respective specialty care service.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3716908&req=5

Figure 1: Percentage of patients in 141 facilities receiving topiramate in FY 2011 by receipt of specialty care. Displayed is the variability in facility level percentage of patients prescribed topiramate by specialty care services. The 141 VA facilities are ordered from smallest to largest percentage and the size of each point represents the number of patients within each respective specialty care service.
Mentions: In the unadjusted single-predictor models, veteran patients with an AUD were more likely to fill a prescription for topiramate in FY 2011 if they were female, younger, had alcohol dependence, were involved in both mental health and addiction specialty care, and had a psychiatric comorbidity (Table 2). These results remained consistent in the adjusted multi-predictor analyses (Table 3). Specifically, patients were more likely to be prescribed topiramate if they were female (OR = 2.50; 95% confidence interval (CI), 2.31, 2.71), were between 30–55 years old compared with >55 (OR = 1.66; 95% CI, 1.56, 1.76), had alcohol dependence versus abuse (OR = 1.15; 95% CI, 1.08, 1.22), were involved in both mental health and addiction specialty care (OR = 3.75; 95% CI, 3.24, 4.43), and had a psychiatric comorbidity (depending on specific psychiatric diagnosis, estimates ranged from OR = 1.74; 95% CI, 1.43, 2.11 for schizophrenia to OR = 4.497; 95% CI, 4.07, 4.96 for other multiple psychiatric diagnoses). Figure 1 displays the facility prescription rates of topiramate by receipt of specialty care.

Bottom Line: 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.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA 94025, USA. aaron.delre@va.gov

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus