Stigma and knowledge gaps impede uptake of medication that helps patients get on the wagon.
Patients hospitalised for alcohol-related reasons were half as likely to return within one month if prescribed alcohol use disorder medication than without, a US study has found.
The study of almost 7000 US Medicare patients compared the outcomes of those who filled prescriptions for naltrexone, acamprosate or disulfiram with those who were not prescribed or did not take up the medication at discharge after an acute care alcohol use disorder (AUD) hospitalisation.
The primary outcome was all-cause mortality or return to hospital, including emergency department visits and readmissions, within 30 days of discharge.
Half of patients (49.7%) discharged without AUD medication returned to hospital within 30 days for any cause, compared with around a quarter (25.5%) of patients who initiated AUD medication on discharge – a 42% relative reduction and an 18% absolute reduction.
In secondary findings, alcohol-related returns to hospital involved 34% of patients discharged without AUD medication versus 15% of those who initiated it on discharge, and patients initiating AUD medication were more likely to have primary care or mental health follow-up than those discharged without AUD medication (54% vs 43% respectively).
“The high rate of return to hospital in the 30 days after alcohol-related hospitalizations and the finding that less than half of such patients attended a primary care or mental health follow-up appointment emphasizes an urgent need to implement interventions to promote more effective transitions of care to the outpatient setting,” wrote the authors in JAMA Network Open.
The authors point out that while medication can be an important part of the treatment for alcohol use disorder, it tends to be underutilised. Only 2% of hospitalisations in the study involved initiation of alcohol use disorder drugs on discharge, which was consistent with other medication surveys in the US.
A similar situation exists in Australia, where low prescribing rates and poor adherence limit their potential benefit. Naltrexone and acamprosate (e.g. Campral) are PBS-subsidised, but disulfiram (e.g. Antabuse) is not subsidised and costs around $80-90 a month.
According to the study authors, part of the reason for the drugs’ underutilisation is limited knowledge about their effectiveness.
“Known barriers for prescribing in the inpatient setting include clinician knowledge gaps, concern about discharge follow-up, lack of institutional prioritization, and stigma of AUD,” they wrote.
However, they noted, prior implementation efforts around AUD hospitalisations have shown promise, and the findings of the current study “support ongoing efforts to increase access to AUD [medication] in the posthospitalisation setting”.
