Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2024-07-19 DOI:10.1002/jhm.13458

Nazima Allaudeen MD, Joyce Akwe MD, Cherinne Arundel MD, Joel C. Boggan MD, Peter Caldwell MD, Paul B. Cornia MD, Jessica Cyr MD, Erik Ehlers MD, Joel Elzweig MD, Patrick Godwin MD, Kirsha S. Gordon PhD, MS, Michelle Guidry MD, Jeydith Gutierrez MD, MPH, Daniel Heppe MD, Matthew Hoegh MD, Anand Jagannath MD, Peter Kaboli MD, MS, FACP, FHM, Michael Krug MD, James D. Laudate MD, Christine Mitchell MD, Micah Pescetto DO, Benjamin A. Rodwin MD, Matthew Ronan MD, Richard Rose MD, Meghna N. Shah MD, Andrea Smeraglio MD, Meredith Trubitt MD, Matthew Tuck MD, Jaclyn Vargas MD, Peter Yarbrough MD, Craig G. Gunderson MD

{"title":"Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study","authors":"Nazima Allaudeen MD, Joyce Akwe MD, Cherinne Arundel MD, Joel C. Boggan MD, Peter Caldwell MD, Paul B. Cornia MD, Jessica Cyr MD, Erik Ehlers MD, Joel Elzweig MD, Patrick Godwin MD, Kirsha S. Gordon PhD, MS, Michelle Guidry MD, Jeydith Gutierrez MD, MPH, Daniel Heppe MD, Matthew Hoegh MD, Anand Jagannath MD, Peter Kaboli MD, MS, FACP, FHM, Michael Krug MD, James D. Laudate MD, Christine Mitchell MD, Micah Pescetto DO, Benjamin A. Rodwin MD, Matthew Ronan MD, Richard Rose MD, Meghna N. Shah MD, Andrea Smeraglio MD, Meredith Trubitt MD, Matthew Tuck MD, Jaclyn Vargas MD, Peter Yarbrough MD, Craig G. Gunderson MD","doi":"10.1002/jhm.13458","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes.</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18–0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33–4.73).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.</p>\n </section>\n </div>","PeriodicalId":15883,"journal":{"name":"Journal of hospital medicine","volume":"19 12","pages":"1122-1130"},"PeriodicalIF":2.4000,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hospital medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jhm.13458","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes.

Objectives

The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence.

Methods

This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression.

Results

Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18–0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33–4.73).

Conclusions

Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.

Abstract Image

查看原文本刊更多论文

治疗酒精使用障碍的药物和戒酒住院后的随访：一项多中心研究。

背景：酒精戒断是急诊入院的常见原因。通常建议处方治疗酒精使用障碍（AUD）的药物并进行密切的门诊随访，但很少有研究报告其对出院后结果的影响：本研究旨在评估治疗 AUD 的药物和随访对再次入院和戒酒的影响：这项回顾性队列研究评估了 2018 年 10 月 1 日至 2019 年 9 月 30 日期间因酒精戒断而在 19 家退伍军人健康管理局医院接受医疗服务的退伍军人。采用逻辑回归法研究了与全因 30 天再入院和 6 个月戒酒相关的因素：在纳入本研究的 594 名患者中，296 人（50.7%）在出院时开具了治疗 AUD 的药物，459 人（78.5%）出院时接受了后续预约，其中 251 人（42.8%）接受了药物滥用门诊预约，191 人（32.9%）接受了药物滥用项目预约，73 人（12.5%）出院后接受了住院治疗。150 名患者（25.5%）在 30 天内因各种原因再次入院，103 名患者（17.8%）在 6 个月后仍然戒毒。治疗 AUD 的药物和门诊出院预约与再入院或戒断无关。出院后接受住院治疗计划与减少 30 天再入院率有关（调整后赔率 [AOR]：0.39，95% 置信区间）：0.39，95% 置信区间 [95% CI]：结论：结论：因酒精戒断而出院的患者再次入院和重新大量饮酒的情况很常见。结论：戒酒出院患者再次入院和恢复酗酒的情况很常见。出院时唯一能改善治疗效果的干预措施是转入住院治疗项目，这与减少再入院和提高戒酒率有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.