Meds rarely initiated after discharge for alcohol use disorder

Patients hospitalized for alcohol use disorder (AUD) rarely initiate medications for AUD (MAUD) after discharge, according to a research letter published online June 27 in the Annals of Internal Medicine.

Eden Y. Bernstein, M.D., from Massachusetts General Hospital in Boston, and colleagues characterized MAUD treatment initiation after AUD hospitalizations using a sample of Medicare Parts A, B, and D beneficiaries with continuous enrollment 12 months before and after cohort entry. A total of 28,601 AUD hospitalizations representing 20,401 unique patients were included in the cohort.

Overall, 206 and 364 patients initiated MAUD treatment within two and 30 days of discharge, respectively (0.7 and 1.3%). Of patients with a primary discharge diagnosis of AUD, 2.3% initiated MAUD treatment within two days of discharge. The researchers found that younger age was the most predictive demographic factor for discharge initiation of MAUD treatment (adjusted odds ratio, 3.87 for age 18 to 39 versus ≥75 years).

Absence of self-directed discharge, psychiatric hospital, or psychiatry or addiction medicine inpatient care versus no addiction medicine or psychiatry, and a primary discharge diagnosis of AUD were the strongest hospitalization predictors (adjusted odds ratios, 18.48, 9.80, 6.23, and 4.75, respectively). Remote MAUD use, female sex, psychiatric disorders, and lower Elixhauser index were additional predictors. Similar predictors were seen for the outcome of MAUD treatment initiation within 30 days.

"Our findings highlight missed opportunities for MAUD treatment initiation among the high-risk group of patients with AUD who are hospitalized," the authors write.

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