[ { "phenotype_id": "PH693", "phenotype_version_id": 1386, "name": "Psychosocial Support", "definition": "Aim:\n\nTo evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care.\n\n\nDesign:\n\nOpen cohort study.\n\n\nSetting:\n\nGeneral practices contributing data to the UK Clinical Practice Research Database.\n\n\nParticipants:\n\n39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013.\n\n\nMain outcome measure:\n\nUse of pharmacotherapy (acamprosate, disulfiram, naltrexone, baclofen and topiramate) to promote abstinence from alcohol or reduce drinking to safe levels in the first 12 months after a recorded diagnosis of alcohol dependence.\n\n\nFindings:\n\nOnly 4,677 (11.7%) of the cohort received relevant pharmacotherapy in the 12 months following diagnosis. Of the 35,303 that did not receive pharmacotherapy, 3,255 (9.2%) received psychosocial support. The remaining 32,048 (80.2%) did not receive either mode of treatment in the first 12 months. Factors that independently reduced the likelihood of receiving pharmacotherapy included: being male (Odds Ratio [OR] 0.74; 95% CI 0.69 to 0.78); older (65-74 years: OR 0.61; 95% CI 0.49 to 0.77); being from a practice based in the most deprived quintile (OR 0.58; 95% CI 0.53 to 0.64); and being located in Northern Ireland (OR 0.78; 95% CI 0.67 to 0.91). The median duration to initiation of pharmacotherapy was 0.80 months (95% CI 0.70 to 1.00) for acamprosate and 0.60 months (95% CI 0.43 to 0.73) for disulfiram. Persistence analysis for those receiving acamprosate and disulfiram revealed that many patients never received a repeat prescription; persistence at 6 months was 27.7% for acomprosate and 33.2% for disulfiram. The median duration of therapy was 2.10 months (95% CI 1.87 to 2.53) for acamprosate and 3.13 months (95% CI 2.77 to 3.36) for disulfiram.\n\n\nConclusion: \n\nDrug therapy to promote abstinence in alcohol dependent patients was low, with the majority of patients receiving no therapy, either psychological or pharmacological. When drug therapy was prescribed, persistence was low with most patients receiving only one prescription. Our data show that treatment for alcohol dependence is haphazard, and there is an urgent need to explore strategies for improving clinical management of this patient group.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Andrew Thompson, Darren M Ashcroft, Lynn Owens, Tjeerd P Van Staa, Munir Pirmohamed, Drug therapy for alcohol dependence in primary care in the UK A Clinical Practice Research Datalink study. POLS ONE, 12(3), e0173272, 2017." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:30:24.908486Z", "author": "Andrew Thompson, Darren M Ashcroft, Lynn Owens, Tjeerd P Van Staa, Munir Pirmohamed", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:30:24.908515Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Lifestyle risk factor", "value": "4" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 } ], "event_date_range": "01/01/1990 - 31/12/2013", "concept_information": [ { "concept_id": 2113, "concept_version_id": 5364, "concept_name": "Psychosocial Support - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH693", "phenotype_version_id": 1386, "phenotype_name": "Psychosocial Support", "code_attribute_header": [ "Entity type", "Category", "Coding System (Read)" ], "codes": [ { "code": "13Y8.00", "description": "Alcoholics anonymous", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "66e0.00", "description": "Alcohol abuse monitoring", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "7P22100", "description": "Delivery of rehabilitation for alcohol addiction", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8CAv.00", "description": "Advised to contact primary care alcohol worker", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8H7p.00", "description": "Referral to community alcohol team", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HHe.00", "description": "Referral to community drug and alcohol team", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HkG.00", "description": "Referral to specialist alcohol treatment service", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8HkJ.00", "description": "Referral to alcohol brief intervention service", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8IAF.00", "description": "brief intervention for excessive alcohol consumptn declined", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8IAJ.00", "description": "Declined referral to specialist alcohol treatment service", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8IAt.00", "description": "Extended intervention for excessive alcohol consumption declined", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "8IEA.00", "description": "Referral to community alcohol team declined", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k1..00", "description": "Alcohol misuse - enhanced services administration", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k11.00", "description": "Alcohol consumption counselling", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k12.00", "description": "Alcohol misuse - enhanced service completed", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k14.00", "description": "Alcohol counselling by other agencies", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k1A.00", "description": "Brief intervention for excessive alcohol consumption completed", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9k1B.00", "description": "Extended intervention for excessive alcohol consumption completed", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "9NN2.00", "description": "Under care of community alcohol team", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Z191100", "description": "alcohol withdrawal regime", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Z191211", "description": "alcohol reduction programme", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "Z4B1.00", "description": "Alcoholism counselling", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZV57A00", "description": "[V]Alcohol rehabilitation", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } }, { "code": "ZV6D600", "description": "[V]Alcohol abuse counselling and surveillance", "attributes": { "Entity type": "res58: psychosocial support", "Category": "diagnostic", "Coding System (Read)": "Read" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/dw7p-7t04", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1386, "version_name": "Psychosocial Support", "version_date": "2021-10-06T16:30:24.937440Z", "is_published": true, "is_latest": true } ] } ]