Case Definition for Alcohol Dependence

Andrew Thompson, Darren M Ashcroft, Lynn Owens, Tjeerd P Van Staa, Munir Pirmohamed

PH692 / 1384 Clinical-Coded Phenotype

  1. Overview

    Phenotype Type
    Lifestyle risk factor
    Sex
    Both
    Valid Event Date Range
    01/01/1990 - 31/12/2013
    Coding System
    Read codes v2
    Data Sources
    CPRD GOLD
    Collections
    ClinicalCodes RepositoryPhenotype Library
    Tags
    No data

  2. Definition

    Aim:

    To evaluate drug therapy for alcohol dependence in the 12 months after first diagnosis in UK primary care.

    Design:

    Open cohort study.

    Setting:

    General practices contributing data to the UK Clinical Practice Research Database.

    Participants:

    39,980 people with an incident diagnosis of alcohol dependence aged 16 years or older between 1 January 1990 and 31 December 2013.

    Main outcome measure:

    Use 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.

    Findings:

    Only 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.

    Conclusion:

    Drug 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.

  3. Implementation

    Implementation

    No data

  4. Clinical Code List

  5. Publication

    • 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.

    Citation Requirements

    No data

  6. API

    To Export Phenotype Details:

    FormatAPI
    JSON site_root/api/v1/phenotypes/PH692/version/1384/detail/?format=json
    R Package

    # Download here

    library(ConceptLibraryClient)


    # Connect to API

    client = ConceptLibraryClient::Connection$new(public=TRUE)


    # Get details of phenotype

    phenotype_details = client$phenotypes$get_detail(
     'PH692',
     version_id=1384
    )

    Py Package

    # Download here

    from pyconceptlibraryclient import Client


    # Connect to API

    client = Client(public=True)


    # Get codelist of phenotype

    phenotype_codelist = client.phenotypes.get_detail(
     'PH692',
     version_id=1384
    )

    To Export Phenotype Code List:

    FormatAPI
    JSON site_root/api/v1/phenotypes/PH692/version/1384/export/codes/?format=json
    CSV site_root/phenotypes/PH692/version/1384/export/codes/
    R Package

    # Download here

    library(ConceptLibraryClient)


    # Connect to API

    client = ConceptLibraryClient::Connection$new(public=TRUE)


    # Get codelist of phenotype

    phenotype_codelist = client$phenotypes$get_codelist(
     'PH692',
     version_id=1384
    )

    Py Package

    # Download here

    from pyconceptlibraryclient import Client


    # Connect to API

    client = Client(public=True)


    # Get codelist of phenotype

    phenotype_codelist = client.phenotypes.get_codelist(
     'PH692',
     version_id=1384
    )

  7. Version History

    Version IDNameOwnerPublish date
    1384 Case Definition for Alcohol Dependence ieuan.scanlon2021-10-06currently shown