linical question: How does the initiation of medications for alcohol use disorder (AUD) at discharge affect 30-day post-discharge outcomes?
Background: AUD is highly prevalent (affecting approximately 29 million adults) and leads to a high rate of health care utilization. Despite guideline recommendations, a majority of U.S. adults with AUD do not receive treatment with medications for AUD (MAUD). Hospitalizations offer a possible opportunity to encourage patients with AUD to engage in treatment with MAUD.
Study design: Retrospective cohort study
Setting: U.S. hospitals admitting Medicare beneficiaries in 2016
Synopsis: 6,794 patients enrolled in Medicare who were hospitalized for AUD in U.S. hospitals in 2016 encompassing 9,834 alcohol-related hospitalizations were included. The primary outcome was a composite of 30-day all-cause mortality or return to hospital. The exposure of interest was MAUD at discharge, which included pharmacy claims for oral naltrexone, acamprosate, or disulfiram that were filled between the day before discharge and two days after discharge. 192 hospitalizations (2.0%) resulted in MAUD initiation on discharge. 30-day all-cause mortality or return to the hospital occurred in 4,843 hospitalizations (49.3%) of which 49 (25.5%) involved MAUD on discharge and 4,794 (49.7%) did not. MAUD at discharge was associated with a 42% relative risk reduction (Incidence Rate Ratio, 0.58 [95% CI, 0.45 to 0.76]) and 18% absolute risk reduction (95% CI, −0.26 to −0.11) in 30-day all-cause mortality or return to hospital. Limitations of this study include unmeasured confounding as a byproduct of the observational study design, an inability to account for long-acting naltrexone injections administered prior to discharge, and an inability to account for non-pharmacologic interventions.
Bottom line: Initiation of naltrexone, acamprosate, or disulfiram prior to discharge or within two days of discharge leads to lower rates of 30-day post-discharge hospital return (emergency department visits and readmissions).
Citation: Bernstein EY, Baggett TP, et al. outcomes after initiation of medications for alcohol use disorder at hospital discharge. JAMA Netw Open. 2024;7(3):e243387. doi:10.1001/jamanetworkopen.2024.3387
Dr. Larson
Dr. Larson is a hospitalist in the division of hospital medicine at NYU Langone Tisch Hospital and a clinical assistant professor of medicine at the NYU Grossman School of Medicine, both in New York.