Treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: A qualitative exploration of barriers and facilitators with service users

IF 3 Q2 SUBSTANCE ABUSE Alcohol (Hanover, York County, Pa.) Pub Date : 2024-08-27 DOI:10.1111/acer.15427
Sofia Hemrage, Stephen Parkin, Nicola Kalk, Naina Shah, Paolo Deluca, Colin Drummond
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Abstract

Background

Effective interventions to improve patient outcomes in comorbid alcohol use disorder (AUD) and alcohol-related liver disease (ARLD) remain a clinical unmet need. While the choice of abstinence is the cornerstone for the prevention of disease progression and mortality, evidence suggests a suboptimal engagement with treatment supporting recovery. This qualitative investigation aims to understand barriers and facilitators to treatment as experienced by this clinical population by applying a multidimensional adherence model proposed by the World Health Organization.

Methods

Twenty-four participants with comorbid AUD and ARLD were recruited from an inpatient clinical setting. Data for this study were collected through semistructured, in-depth interviews. Deductive analysis was organized by the Framework method, and theory-driven themes were identified according to the multidimensional adherence model. This included factors across the social and economic, patient, condition, treatment, and healthcare system levels.

Results

The findings in this study indicate systematic challenges in maintaining continuity between primary, secondary, and community care. Aspects related to social and economic context, treatment, and healthcare systems were found to hinder engagement. Identified facilitators to engagement included the participatory role of family, shared lived experience of addiction/recovery, and therapeutic alliance with healthcare providers.

Conclusion

The understanding of these barriers and facilitators from a service user's perspective can bridge the treatment gap for this clinical population. This can provide an opportunity for the implementation of effective interventions and inform the development of policies promoting accessible care. Government and public health bodies have fundamental roles in shifting treatment paradigms in comorbid AUD and ARLD.

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合并酒精使用障碍和酒精相关肝病的治疗参与度:与服务使用者一起对障碍和促进因素进行定性探索。
背景:改善合并酒精使用障碍(AUD)和酒精相关肝病(ARLD)患者治疗效果的有效干预措施仍是临床未满足的需求。虽然选择戒酒是预防疾病恶化和死亡的基石,但有证据表明,参与支持康复治疗的效果并不理想。本定性调查旨在通过应用世界卫生组织提出的多维依从性模型,了解该临床人群在治疗过程中遇到的障碍和促进因素:从住院临床环境中招募了24名合并有AUD和ARLD的参与者。本研究通过半结构式深度访谈收集数据。采用框架法进行演绎分析,并根据多维依从性模型确定了理论驱动的主题。这包括社会和经济、患者、病情、治疗和医疗系统等各个层面的因素:本研究的结果表明,在保持初级、二级和社区医疗之间的连续性方面存在系统性挑战。研究发现,与社会和经济环境、治疗和医疗保健系统相关的因素阻碍了患者的参与。已确定的促进参与的因素包括家庭的参与作用、共同的成瘾/康复生活经历以及与医疗服务提供者的治疗联盟:结论:从服务使用者的角度了解这些障碍和促进因素,可以弥补这一临床人群的治疗差距。这可以为实施有效的干预措施提供机会,并为制定促进无障碍护理的政策提供信息。政府和公共卫生机构在转变合并症 AUD 和 ARLD 的治疗模式方面发挥着重要作用。
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