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

Authors

Nazima Allaudeen, Medical Service, VA Palo Alto Healthcare System, Palo Alto, California, USA.
Joyce Akwe, Medical Service, Atlanta VA Medical Center, Atlanta, Georgia, USA.
Cherinne Arundel, Medical Service, VA Washington DC Health Care System, Washington, District of Columbia, USA.
Joel C. Boggan, Medical Service, Durham VA Medical Center, Durham, North Carolina, USA.
Peter Caldwell, Medical Service, New Orleans VA Medical Center, New Orleans, Louisiana, USA.
Paul B. Cornia, University of Washington School of Medicine, Seattle, Washington, USA.
Jessica Cyr, Medical Service, Pittsburgh VA Medical Center, Pittsburgh, Pennsylvania, USA.
Erik Ehlers, Medical Service, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA.
Joel Elzweig, Medical Service, White River Junction VA Medical Center, White River Junction, Vermont, USA.
Patrick Godwin, Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois, USA.
Kirsha S. Gordon, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Michelle Guidry, Medical Service, New Orleans VA Medical Center, New Orleans, Louisiana, USA.
Jeydith Gutierrez, Section of Hospital Medicine, Iowa City VA Healthcare System, Iowa City, Iowa, USA.
Daniel Heppe, VA Eastern Colorado Health Care System, Aurora, Colorado, USA.
Matthew Hoegh, VA Eastern Colorado Health Care System, Aurora, Colorado, USA.
Anand Jagannath, Medical Service, VA Portland Healthcare System, Portland, Oregon, USA.
Peter Kaboli, Section of Hospital Medicine, Iowa City VA Healthcare System, Iowa City, Iowa, USA.
Michael Krug, University of Washington School of Medicine, Seattle, Washington, USA.
James D. Laudate, Medical Service, White River Junction VA Medical Center, White River Junction, Vermont, USA.
Christine Mitchell, Medical Service, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, USA.
Micah Pescetto, Medical Service, VA Kansas City Health Care, Kansas City, Missouri, USA.
Benjamin A. Rodwin, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Matthew Ronan, Medical Service, General Internal Medicine Section, VA Boston Healthcare System, West Roxbury, Massachusetts, USA.
Richard Rose, Medical Service, Salt Lake City VA Medical Center, Salt Lake City, Utah, USA.
Meghna N. Shah, University of Washington School of Medicine, Seattle, Washington, USA.
Andrea Smeraglio, Medical Service, VA Portland Healthcare System, Portland, Oregon, USA.
Meredith Trubitt, Medical Service, Atlanta VA Medical Center, Atlanta, Georgia, USA.
Matthew Tuck, Medical Service, VA Washington DC Health Care System, Washington, District of Columbia, USA.
Jaclyn Vargas, Medical Service, San Diego VA Medical Center, San Diego, California, USA.
Peter Yarbrough, Medical Service, Salt Lake City VA Medical Center, Salt Lake City, Utah, USA.
Craig G. Gunderson, VA Connecticut Healthcare System, West Haven, Connecticut, USA.

Document Type

Journal Article

Publication Date

7-19-2024

Journal

Journal of hospital medicine

DOI

10.1002/jhm.13458

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.

Department

Medicine

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