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- Title
Outcomes After Initiation of Medications for Alcohol Use Disorder at Hospital Discharge.
- Authors
Bernstein, Eden Y.; Baggett, Travis P.; Trivedi, Shrunjal; Herzig, Shoshana J.; Anderson, Timothy S.
- Abstract
This cohort study investigates the association of medications for alcohol use disorder initiated at hospital discharge with return to hospital or death after alcohol-related hospitalizations. Key Points: Question: Is the initiation of medications for alcohol use disorder at hospital discharge associated with 30-day clinical outcomes among Medicare Part D beneficiaries? Findings: In this cohort study of 9834 alcohol-related hospitalizations, discharge initiation of medications for alcohol use disorder was associated with an absolute risk reduction of 18% in the composite outcome of return to hospital or death within 30 days compared with no initiation. Meaning: These findings support efforts to increase initiation of medications for alcohol use disorder at hospital discharge. Importance: US Food and Drug Administration–approved medications for alcohol use disorder (MAUD) are significantly underused. Hospitalizations may provide an unmet opportunity to initiate MAUD, but few studies have examined clinical outcomes of patients who initiate these medications at hospital discharge. Objective: To investigate the association between discharge MAUD initiation and 30-day posthospitalization outcomes. Design, Setting, and Participants: This cohort study was conducted among patients with Medicare Part D who had alcohol-related hospitalizations in 2016. Data were analyzed from October 2022 to December 2023. Exposures: Discharge MAUD initiation was defined as oral naltrexone, acamprosate, or disulfiram pharmacy fills within 2 days of discharge. Main outcomes: The primary outcome was a composite of all-cause mortality or return to hospital (emergency department visits and hospital readmissions) within 30 days of discharge. Secondary outcomes included these components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. Propensity score 3:1 matching and modified Poisson regressions were used to compare outcomes between patients who received and did not receive discharge MAUD. Results: There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 [46-62] years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 192 hospitalizations (2.0%) involved discharge MAUD initiation. After propensity matching, discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58 [95% CI, 0.45 to 0.76]; absolute risk difference, −0.18 [95% CI, −0.26 to −0.11]). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56 [95% CI, 0.43 to 0.73]) except for mortality, which was rare in both groups (incident rate ratio, 3.00 [95% CI, 0.42 to 21.22]). Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital (incident rate ratio, 0.49 [95% CI, 0.34 to 0.71]; absolute risk difference, −0.15 [95% CI, −0.22 to −0.09]). Conclusion and relevance: In this cohort study, discharge initiation of MAUD after alcohol-related hospitalization was associated with a large absolute reduction in return to hospital within 30 days. These findings support efforts to increase uptake of MAUD initiation at hospital discharge.
- Subjects
MORTALITY prevention; MORTALITY risk factors; RISK assessment; POISSON distribution; MEDICAL prescriptions; CENTERS for Medicare &; Medicaid Services (U.S.); RESEARCH funding; HOSPITAL care; ALCOHOL deterrents; MEDICARE; PATIENT readmissions; PROBABILITY theory; TREATMENT effectiveness; DISCHARGE planning; UNITED States. Food &; Drug Administration; DESCRIPTIVE statistics; ALCOHOL-induced disorders; DRUG approval; LONGITUDINAL method; ODDS ratio; ACAMPROSATE calcium; DATA analysis software; CONFIDENCE intervals; SOCIODEMOGRAPHIC factors; NARCOTIC antagonists; DISULFIRAM; NALTREXONE; REGRESSION analysis; NOSOLOGY; SENSITIVITY &; specificity (Statistics); EVALUATION
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe243387
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.3387