Hospital Readmission in Alcohol Use Disorder Patients: The Role of Anti-Craving Medications and Discharge Disposition.
Hospital Readmission in Alcohol Use Disorder Patients: The Role of Anti-Craving Medications and Discharge Disposition.
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DOI：
10.36518/2689-0216.1243
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发表时间：
2022-01-01
期刊：
影响因子：
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通讯作者：
Jo, Young
中科院分区：
文献类型：
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作者：
Calabrese, Jordan;Brown, Jonathan;Jo, Young
背景：酒精使用障碍 (AUD) 导致频繁再入院。尽管文献显示了抗渴药（ACM）的功效，但很少在出院时开处方。排放至物质使用治疗设施 (STF) 的后果也尚未得到充分探讨。本研究旨在确定 ACM 以及出院至 STF 对 AUD 患者再入院的影响。方法：这项回顾性病例对照研究分析了 2016 年至 2018 年美国 HCA Healthcare 医院内针对 AUD 成人患者的遭遇。病例定义是出院时存在 ACM（定义为阿坎酸或纳曲酮）以及出院处置（STF 与所有其他）。主要结果是与 AUD 下降/未转至 STF 或不使用 ACM 的成人相比，病例 30 天和 90 天再入院的可能性以及 30 天再入院的血液酒精浓度 (BAC)。控制变量包括年龄、性别、种族和保险状况。结果：本研究共确定了 14 691 名患者。其中，3308 名患者接受了 ACM 治疗，1125 名患者出院至 STF。无 ACM 的患者在 30 天内再次入院的可能性是其 1.18 倍（95% CI，1.07-1.30；P = .0005）。出院至 STF 的患者在 30 天内再次入院的可能性高出 1.57 倍（95% CI，1.37-1.79；P < .0001），但这些患者在 30 天再入院时的 BAC 比未出院至 STF 的患者低 26.74 个单位。结论：出院时服用 ACM 处方与 30 天再入院率降低相关。 30 天内重新入院的患者 BAC 较低，表明从长远来看，出院至 STF 可能有利于 AUD 的治疗。鼓励从业者为因 AUD 入院的患者开 ACM 处方，以减少 30 天再次入院的可能性。
Background: Alcohol use disorder (AUD) results in frequent hospital readmissions. Although the literature has shown the efficacy of anti-craving medications (ACM), they are infrequently prescribed upon discharge. The outcomes of discharge to substance use treatment facilities (STF) have also not been fully explored. This study seeks to determine the impact of ACM as well as discharge to STF on readmissions for people with AUD.Methods: This retrospective case-control study analyzed encounters made within HCA Healthcare hospitals across the United States from 2016 to 2018 for adults with AUD. The case definition was the presence of ACM defined as acamprosate or naltrexone upon discharge as well as discharge disposition (STF vs. all others). The main outcomes were the likelihood of 30- and 90-day readmission and blood alcohol concentration (BAC) on 30-day readmission in cases versus adults with AUD declining/not referred to an STF or not using ACM. The controlled variables included age, sex, race, and insurance status.Results: A total of 14 691 patients were identified for the study. Of these, 3308 patients were prescribed ACM and 1125 patients were discharged to an STF. Patients without ACM were 1.18 times more likely to be readmitted within 30 days (95% CI, 1.07-1.30; P = .0005). Patients discharged to an STF were 1.57 times more likely to be readmitted within 30 days (95% CI, 1.37-1.79; P < .0001), but these patients had a BAC that was 26.74 units lower on 30-day readmission than those who were not discharged to an STF.Conclusion: The prescription of ACM on discharge was associated with decreased 30-day readmission rates. The lower BAC of those who were readmitted within 30 days suggests discharge to STF may be beneficial for the treatment of AUD in the longer term. Practitioners are encouraged to prescribe ACM for people admitted with AUD to reduce the likelihood of 30-day readmission.