Only about 2% of patients with alcohol use disorder start treatment after discharge

Key takeaways:

• Only 2.3% of patients with a primary discharge diagnosis of alcohol use disorder initiate treatment within 2 days of discharge.
• Researchers said providers like generalists need to prescribe more for AUD.

Few patients hospitalized for alcohol use disorder, or AUD, were treated with approved medications that could help to enable behavior change, a study published in the Annals of Internal Medicine showed.

According to Eden Y. Bernstein, MD, a general internal medicine fellow at Massachusetts General Hospital, and colleagues, approximately 29 million U.S. adults have AUD, which contributes to more than 140,000 deaths annually.

Despite the disorder’s substantial prevalence and the mortality risk associated with it, low prescribing rates of medications for AUD (MAUD) — such as naltrexone, acamprosate or disulfiram — have been previously observed in single center studies, the researchers pointed out.

“However, nationwide data on MAUD treatment initiation after hospitalization are lacking,” they wrote in the Annals of Internal Medicine.

To characterize national MAUD trends, Bernstein and colleagues used a national sample of Medicare part D claims from 2015 to 2017. The cohort included 28,601 AUD hospitalizations that represented 20,401 unique patients.

Among all patients, only 0.7% and 1.3% and initiated MAUD treatment within 2 days and 30 days of discharge, respectively. Meanwhile, 2.3% of patients with a primary diagnosis of AUD initiated MAUD treatment within 2 days of discharge.

The researchers found that patients aged 18 to 39 years were more likely to receive MAUD initiation compared with older patients (adjusted OR = 3.87; 95% CI, 1.34-11.16).

Patients were also more likely to start therapy if they:

• had received care in a psychiatric hospital (aOR = 9.8; 95% CI, 5.54-17.34);
• received psychiatry or addiction medicine inpatient care (aOR = 6.23; 95% CI, 3.68-10.57); or
• received a primary discharge diagnosis of AUD (aOR = 4.75; 95% CI, 2.91-7.74).

Additionally, the South (aOR = 0.71; 95% CI, 0.52-0.96) and West (aOR = 0.62; 95% CI, 0.4-0.97) regions were linked to a reduced likelihood of initiating MAUD compared with the Northeast.

Bernstein and colleagues underscored that initiation of MAUD should be involved in long-term treatment plans, “and if this is not feasible during hospitalization, then referral for outpatient treatment may be a preferred alternative.”

Ultimately, “hospitalizations should be leveraged for interventions to initiate MAUD treatment as part of a comprehensive treatment plan,” they wrote.

The researchers concluded that although increased access to psychiatry or addiction

medicine presents a possible solution to increase MAUD initiation rates, increased prescribing by nonspecialists and generalists is needed to “bridge the gap.”

In a related editorial, Michael F. Mayo-Smith, MD, MPH, a clinical assistant professor of medicine at Dartmouth Geisel School of Medicine, and David Lawrence, MD, an assistant professor at David Geffen School of Medicine at UCLA, noted that hospitalists and other providers should familiarize themselves with MAUD, develop brief intervention skills and recognize the value of addiction medication consultations.

They added that health systems need to ensure availability of addiction medication consultations, “with consideration of telehealth consultation services for rural hospitals and those without sufficient local expertise in addiction medicine.”

“Unfortunately, the availability of evidence-based treatments for AUD does not by itself lead to improved care,” Mayo-Smith and Lawrence concluded. “We need strategies for widespread adoption so that patients can realize the benefits of these treatments.”

References:

• Bernstein E, et al. Ann Intern Med. 2023;doi:10.7326/M23-0641.
• Mayo-Smith M, Lawrence D. Ann Intern Med. 2023;doi:10.7326/M23-1419.