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Just 1 in 5 Patients With Alcohol-Related Diagnosis Prescribed Medication to Treat AUD
Just 5% of patients with an alcohol-related diagnosis across settings at a regional health system were prescribed naltrexone, disulfiram, or acamprosate—the drugs approved to treat alcohol use disorder (AUD)—findings that indicate underprescribing of such medications, despite their demonstrated effectiveness in reducing heavy drinking and/or relapse.
The study was reported in Alcoholism: Clinical and Experimental Research.
“Compared to inpatient substance use treatment, inpatient acute care hospitalizations for AUD was associated with a 93% reduced odds of receiving medications for AUD,” reported corresponding author Sarah E. Jolley, MD, and colleagues from the University of Colorado Department of Medicine, Aurora, Colorado.
Researchers examined prescribing data in the inpatient acute care setting—a venue in which prescription of AUD medications was found to be feasible and associated with a reduction in readmissions and emergency department visits—compared with other settings within the University of Colorado Healthcare System.
Electronic health record data for adult patients with an alcohol-related diagnosis between 2016 and 2019 were studied. Over 48,000 patients with more than 136,000 alcohol-related encounters were identified. Encounters most commonly took place in emergency departments (42%), inpatient substance use treatment (18%), inpatient acute care (17%), and outpatient primary care (12%) settings.
Across all settings, 5% of patients were prescribed AUD medications. Female sex and addiction medicine consults were associated with higher AUD medication prescribing rates, and alcohol encounters in emergency departments, inpatient acute care, and ICU settings, as well as Hispanic ethnicity and Black or non-White race were negative predictors for prescribing.
In a news release announcing the findings, the researchers said, “[A]lthough not every patient will be appropriate for or want medication for AUD, current prescribing practices appear inadequate. An acute care hospitalization may provide a key opportunity for patients motivated by their illness to make health-related changes, warranting further attention to initiation of medications for AUD in this setting.”
The researchers also noted that prescribing rates in acute care settings may benefit from more direct involvement of an addiction medicine consultation or inpatient SUD experts. They also advocated for increased AUD medication-related education for hospitalists, intensivists, and generalists to increase familiarity with the medications and their use in high-risk populations.
“AUD-related emergency department and inpatient acute care hospital encounters in our health re system were common. Nevertheless, prescriptions for medications for AUD were infrequent in this population, particularly in inpatient settings,” the authors wrote. “Our findings suggest that the initiation of medications for AUD for patients with alcohol-related diagnoses in acute care settings deserves additional evaluation.”
Jolynn Tumolo contributed to this report.
Editor's note: This story was updated on July 12, 2022, to add context about the study.
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