Prescribing AUD medication at hospital discharge lowers risk of readmission

For adults hospitalized for alcohol-related reasons, receiving a prescription for an alcohol use disorder (AUD) medication at the time of discharge may lower their risk of return to hospital within 30 days of discharge, including emergency room visits and readmissions.

That's according to a recent study published in JAMA Network Open led by researchers at Massachusetts General Hospital (MGH) and the University of Pittsburgh.

For the study, the investigators identified 9,834 alcohol-related hospitalizations among 6,794 Medicare Part D beneficiaries across the United States in 2016. Only 2.0% of hospitalizations involved filled prescriptions for alcohol use disorder medications-;including oral naltrexone, acamprosate, and disulfiram-;at the time of discharge.

Return to the hospital or death within 30 days (the combined primary outcome assessed in the study) occurred among 49.3% of hospitalizations overall, including 25.5% of hospitalizations that involved prescriptions for alcohol use disorder medications at discharge and 49.7% of hospitalizations that did not.

After controlling for important differences between the two groups, the investigators observed that there were 42% fewer returns to the hospital or deaths within 30 days among patients who received such discharge prescriptions compared with those who did not. Regarding absolute risk, patients with these discharge prescriptions had an 18% lower risk of returning to the hospital or dying than other patients.

Similar results were seen for alcohol-related hospital returns. Those who received medications were also 22% more likely to have primary care or mental health follow-up visits. Differences in mortality alone were not apparent because deaths within 30 days were rare in both groups (approximately 1%).

Despite known efficacy, medication treatment for alcohol use disorder is underutilized and rarely initiated in the post-hospitalization setting. Our findings highlight the potential clinical benefit associated with increased uptake of these medications in this setting and suggest a need to support and expand ongoing efforts to improve access to these medications upon hospital discharge."

Eden Y. Bernstein, MD, lead author, physician scientist in the Division of General Internal Medicine at MGH

"These therapies are evidence based, inexpensive, and have manageable side effects," says senior author Timothy Anderson, MD, MAS, a primary care physician, health services researcher and assistant professor of medicine at the University of Pittsburgh, who began on the study while on the faculty at Harvard University. "Given the potential upsides demonstrated in this study, training inpatient clinicians to initiate these medications and to develop plans for post-hospital follow up with patients and their primary care team has the potential to improve patient outcomes and to reduce preventable readmissions."

Additional authors include Travis P. Baggett, MD, MPH, Shrunjal Trivedi, MPH, Shoshana J. Herzig, MD, MPH, and Timothy S. Anderson, MD, MAS.

This work was funded by the Agency for Healthcare Research and Quality and the National Institute on Aging.