Differences in Perceptions of and Practices Regarding Treatment of Alcohol Use Disorders Among VA Primary Care Providers in Urban and Rural Clinics

• Published in: The Journal of rural health Vol. 34; no. 4; pp. 359 - 368
• Main Authors: Young, Jessica P., Achtmeyer, Carol E., Bensley, Kara M., Hawkins, Eric J., Williams, Emily C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2018
• Subjects: Access; Addictions; Alcohol related disorders; Alcohol use; alcohol use disorder; Alcoholism; Alcohols; Barriers; Clinics; Community centers; Community health services; Constraints; Content analysis; Data collection; Disorders; Drug therapy; Experts; Health care; Health care facilities; Health care policy; Health services; Integrated care; Medical personnel; Medicine; Occupational health; Outpatient clinics; Patients; Perceptions; Pharmacology; Primary care; Qualitative analysis; Qualitative research; Referrals; rural; Rural areas; Rural communities; Rural health care; Rural urban differences; Specialists; Substance abuse treatment; Substance use disorder; Treatment methods; urban; Urban areas; Urban health care; Veterans; alcohol use disorder; primary care; veterans; urban; rural
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12293

Background Effective behavioral and pharmacological treatments are available and recommended for patients with alcohol use disorders (AUD) but rarely received. Barriers to receipt and provision of evidence‐based AUD treatments delivered by specialists may be greatest in rural areas. Methods A targeted subanalysis of qualitative interview data collected from primary care providers at 5 Veterans Affairs clinics was conducted to identify differences in provider perceptions and practices regarding AUD treatment across urban and rural clinics. Key contacts were used to recruit 24 providers from 3 “urban” clinics at medical centers and 2 “rural” community‐based outpatient clinics. Providers completed 30‐minute semistructured interviews, which were recorded, transcribed, and analyzed using inductive content analysis. Results Thirteen urban and 11 rural providers participated. Urban and rural providers differed regarding referral practices and in perceptions of availability and utility of specialty addictions treatment. Urban providers described referral to specialty treatment as standard practice, while rural providers reported substantial barriers to specialty care access and infrequent specialty care referral. Urban providers viewed specialty addictions treatment as accessible and comprehensive, and perceived addictions providers as “experts” and collaborators, whereas rural providers perceived inadequate support from the health care system for AUD treatment. Urban providers desired greater integration with specialty addictions care while rural providers wanted access to local addictions treatment resources. Conclusions Providers in rural settings view referral to specialty addictions treatment as impractical and resources inadequate to treat AUD. Additional work is needed to understand the unique needs of rural clinics and decrease barriers to AUD treatment.