Naltrexone Initiation in the Inpatient Setting for Alcohol Use Disorder: A Systematic Review of Clinical Outcomes.
Naltrexone Initiation in the Inpatient Setting for Alcohol Use Disorder: A Systematic Review of Clinical Outcomes.
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DOI：
10.1016/j.mayocpiqo.2021.01.013
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Chaudhary R
中科院分区：
文献类型：
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作者：
Kirchoff RW;Mohammed NM;McHugh J;Markota M;Kingsley T;Leung J;Burton MC;Chaudhary R
酒精使用障碍（AUD）在美国是一个非常普遍的健康问题。尽管有强有力的证据表明其有效性，但接受药物辅助治疗（MAT）的人数有限。住院环境可能是启动MAT的重要机会。本研究的目的是总结急诊或住院环境中纳曲酮启动aud管理的数据。我们检索了从成立到2019年10月31日的ClinicalTrials.gov、Ovid EBM Reviews、Ovid Embase、Ovid Medline、Ovid PsycINFO、Scopus和Web of Science。使用关键字（补充附录1，可在http://www.mcpiqojournal.org在线获得）和与住院AUD患者纳曲酮治疗相关的标准化索引词的组合创建搜索策略。两项无控制的前后研究设计评估了纳曲酮处方率、30天再入院率和再住院率。两位作者独立提取了有关研究特征、结果和研究水平偏倚风险的数据。研究小组合作评估了所有研究的证据强度。两项研究报告说，实施纳曲酮起始方案增加了MAT率，其中一项研究指出，30天住院再入院率大幅下降。总的来说，我们发现在AUDs的住院环境中缺乏纳曲酮起始治疗的数据。这可能反映了当前临床实践的性质和处方者的舒适度。有必要进一步研究评估MAT在住院环境中的启动。此外，还需要进一步探索如何提高提供者对这些治疗选择的认识。
Alcohol use disorder (AUD) is a highly prevalent health issue in the United States. The number of those receiving medication-assisted treatment (MAT) is limited, despite strong evidence for their effectiveness. The inpatient setting may represent an important opportunity to initiate MAT. The goal of this study was to summarize the data on naltrexone initiation in the emergency department or inpatient setting for the management of AUDs. We searched ClinicalTrials.gov, Ovid EBM Reviews, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science from inception through October 31, 2019. Search strategies were created using a combination of keywords (Supplemental Appendix 1, available online at http://www.mcpiqojournal.org) and standardized index terms related to naltrexone therapy for medically hospitalized patients with AUD. Two uncontrolled pre-post study designs evaluated naltrexone prescription rates, 30-day readmission rates, and rehospitalization rates. Two authors independently abstracted data on study characteristics, results, and study-level risk of bias. The research team collaborated to assess the strength of evidence across studies. Two studies reported that implementing a protocol for naltrexone initiation increased MAT rates, with one study noting a substantial decrease in 30-day hospital readmissions. Overall, we found that there is a paucity of data on naltrexone initiation in the inpatient setting for AUDs. This likely reflects the nature of current clinical practice and prescriber comfortability. There is a need for further studies evaluating MAT initiation in the inpatient setting. Furthermore, efforts to increase provider knowledge of these therapeutic options are in need of further exploration.