3/29/2024
PITTSBURGH – When medications for alcohol use disorder are prescribed upon discharge to patients hospitalized for alcohol-related reasons, outcomes are markedly improved, according to a new study published in JAMA Network Open and led by researchers at the University of Pittsburgh School of Medicine and Massachusetts General Hospital.
The study highlights the untapped potential of these medications, which are evidence-based and inexpensive. It also builds on the researchers’ previous finding that among Medicare patients who have the most severe cases of the disorder, only 2% receive these prescriptions when they leave the hospital.
The team examined 6,794 Medicare Part D beneficiaries in 2016, who collectively had 9,834 alcohol-related hospitalizations that year. The researchers compared 30-day outcomes for those who received medications such as oral naltrexone, acamprosate and disulfiram after being discharged, versus outcomes of those who did not.
The researchers found that those who received a medication for alcohol use disorder were 42% less likely to have visited an emergency department, been readmitted to a hospital or died one month after discharge. Additionally, subsequent visits to primary care and mental health care providers were 22% more likely in the group who received medications.
Physicians often don’t feel prepared to prescribe these medications, said senior author Timothy Anderson, M.D., M.A.S., a primary care physician at UPMC and health services researcher and assistant professor of medicine at Pitt. “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 teams has the potential to improve patient outcomes and to reduce preventable readmissions."
“Despite the known efficacy, medication treatment for alcohol use disorder is underutilized and rarely initiated in the post-hospitalization setting,” said lead author Eden Y. Bernstein, M.D., a general internal medicine research fellow in the Division of General Internal Medicine at Massachusetts General Hospital. “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.”
Additional authors include Travis P. Baggett, M.D., M.P.H., of Massachusetts General Hospital; and Shrunjal Trivedi, M.P.H., and Shoshana J. Herzig, M.D., M.P.H., of Beth Israel Deaconess Medical Center.
This work was funded by the Agency for Healthcare Research and Quality and the National Institute on Aging (K76AG074878).