Information Dissemination Core Alcohol use disorders (AUDs) are among the top 5 modifiable factors leading to premature death. We have devoted much effort in past cycles to development of educational materials for the medical and legal professions related to recognition of AUDs, most recently assisting in the implementation of screening, brief intervention, and referral to treatment (SBIRT) in Indianapolis's public hospital system. There is a critical need to understand why medical and (perhaps) legal professionals do not take a more active role in their approach to patients identified as having hazardous alcohol use, and particularly, and what can be done to improve the very low rate of medication-assisted treatment (MAT) to help patients reduce their drinking. Our objective is to learn about barriers in medical and legal systems to active treatment of hazardous drinking, and test the ability of education about and reminders to improve outcomes (use of MAT and referral of clients to alcohol assessment). The central hypothesis is that a combination of education and reminders in the medical and court record systems will increase the prescription rates of drugs to reduce alcohol use and the referral of patients with possible AUDs to assessment from the courts.
Our specific aims are to: a) survey a wide variety of medical providers, behavioral health specialists, pharmacists, administrative leadership, and patients (and parents of minors) in the Eskenazi Health system about their knowledge of effectiveness of MAT for hazardous drinking, their reasons for not prescribing or authorizing drugs for these patients, and educate them about the evidence for treatment effectiveness; b) survey judges about their practices regarding ordering assessments and treatment of defendants for alcohol and drug abuse, and compare these results with case reviews. We will test an intervention that includes education about the effectiveness of alcohol and drug treatment and computer-generated reminders for referral; and c) develop an education module and computer-generated reminders for the use of MAT for AUDs and test their effect in a large, urban primary care network, targeting groups less often screened including adolescents and young women. The expected outcomes are better understanding of the barriers to use of MAT for alcohol abuse, and increased use of these drugs when triggered by reminders. We expect that the e-textbook will be widely used by law students and judges, and targeted reminders will increase the percentage of individuals involved in alcohol-related crimes who are referred for assessment. The positive impact of this work will be a reduction in the number of individuals with hazardous drinking progressing to compulsive drinking.
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