Pharmacologic Treatment Initiation Among Medicare Beneficiaries Hospitalized With Alcohol Use Disorder

Bernstein, Eden; Baggett, Travis P.; Trivedi, Shrunjal; Herzig, Shoshana J.; Anderson, Timothy S.

doi:10.7326/m23-0641

Cited by 11 publications

(14 citation statements)

References 4 publications

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“…While this may be true, it would also be important to consider if there have been shifts in the relative distribution of types of hospitalization (eg, an increase in the proportion of hospitalizations for acute intoxication vs liver disease) that might underlie the overall changes in in-hospital mortality. Similar considerations should also be made when interpreting the results of other recent population-based analyses of alcohol-related health service use in Canada and internationally . Of course, there will be some variation in the subtypes of individuals who experience alcohol-related hospitalizations between jurisdictions.…”

Section: Discussionmentioning

confidence: 91%

“…All this research, including corroborating international reports, has generated substantial interest in monitoring national trends in alcohol-related hospitalizations and developing strategies to reduce the risk of postdischarge harm and recurrent health service use. However, much of this work amalgamates everyone who experiences an alcohol-related hospitalization into a single cohort of individuals with a presumed AUD . In turn, there has been relatively little focus on the clinical diversity that exists within this population or if certain subgroups merit prioritization in efforts to reduce the risk of adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Friesen,

Mataruga,

Nickel

et al. 2024

JAMA Netw Open

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ImportanceAlcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm.ObjectiveTo identify and characterize the clinical subgroups of individuals who are hospitalized for alcohol-related harms.Design, Setting, and ParticipantsThis cohort study used latent class analysis (LCA) to identify clinical subgroups of individuals experiencing alcohol-related hospitalizations in 2 provinces in Canada. All individuals between ages 10 and 105 years who were hospitalized for an alcohol-related harm between January 2017 and December 2018 (ie, the index hospitalization) were eligible. Data were analyzed between June 2023 and August 2023.ExposuresThe exposure of interest was the clinical subgroup that an individual belonged to. These subgroups were identified using an LCA based on (1) the characteristics of the index hospitalization and (2) the history of alcohol-related health service use.Main Outcomes and MeasuresIn-hospital mortality, alcohol-related hospital readmission, and all-cause mortality in the year following discharge from the index hospitalization. The association between subgroup membership and the risk of in-hospital and postdischarge outcomes was evaluated using multivariable regression.ResultsA total of 34 043 individuals were included in analysis, 4753 from Manitoba (median [IQR] age, 49 [40-58] years; 1786 female [37.6%]) and 29 290 from Ontario (median [IQR] age, 57 [45-67] years; 8527 female [29.1%]). Seven subgroups were identified following a gradient from low-frequency service use for acute intoxication to high-frequency service use for severe alcohol use disorder and liver disease. In Ontario, there were 4431 individuals in the liver disease subgroup representing 15.5% of the cohort who were at the highest risk of 1-year mortality (1382 [31.2%]) relative to the acute intoxication subgroup (42 [4.0%]) (adjusted hazard ratio [aHR], 3.83; 95% CI, 2.80-5.24). There was also a small subgroup (10.6%) of individuals with high-frequency alcohol-related health service use who had a much higher hazard of readmission following the index hospitalization (1-year readmission: 703 of 1526 [46.1%] vs 104 of 1058 [9.8%] in the acute intoxication subgroup; aHR, 5.09; 95% CI, 4.11-6.31).Conclusions and RelevanceIn this population-based cohort study of individuals experiencing alcohol-related hospitalizations, we identified several small, clinically distinct subgroups that were at a disproportionately high risk of readmission and mortality. These groups could merit prioritization in strategies aimed at reducing the risk of adverse outcomes following alcohol-related hospitalizations.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Friesen,

Mataruga,

Nickel

et al. 2024

JAMA Netw Open

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“…Greater engagement of inpatient addictions services might also help promote use of MAUD. 6,11 Addressing this treatment gap also requires an understanding of system-level barriers to MAUD prescribing. A recent mixed-methods study highlighted barriers to starting MAUD in inpatient settings.…”

mentioning

confidence: 99%

“…Starting MAUD is especially infrequent during or after hospitalization. A study of nearly 30 000 Medicare beneficiaries with alcohol-related hospitalizations in 2016 showed that only approximately 1% received MAUD within a month of hospital discharge . Hospitalization, therefore, represents an important missed opportunity for engaging patients in treatment.…”

mentioning

confidence: 99%

“…The results also reaffirm the underuse of MAUD: among the nearly 10 000 admitted patients eligible for study inclusion, only 1 in 50 filled a discharge prescription . This low rate of use is consistent with past studies . However, the infrequency of prescriptions raises questions about the external generalizability and the extent to which the dramatic reduction in subsequent use of acute care services reflects the effects of MAUD alone.…”

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confidence: 99%

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Sobering Perspectives on the Treatment of Alcohol Use Disorder

Yaseen,

Mong,

Zipursky

2024

JAMA Netw Open

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Alcohol misuse is a leading cause of preventable suffering globally. Each year in the United States, alcohol misuse contributes to 140 000 deaths and nearly 3.6 million years of potential life lost. 1,2 Economic losses and health costs are staggering because alcohol can contribute to death and disability early in life. In 2010, the economic burden of alcohol misuse in the United States was estimated at a quarter of a trillion dollars, which is equivalent to $807 per person, or $2.05 per drink. 3 Treatment options for the 30 million individuals with alcohol use disorder (AUD) 4 in the US include behavioral interventions and pharmacotherapy. Naltrexone, acamprosate, and disulfiram are 3 approved drugs for treating AUD. Since disulfiram works only through aversive effects, with no Open Access. This is an open access article distributed under the terms of the CC-BY License.

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Does This Patient Have Alcohol Use Disorder?

Wood,

Pan,

Cui

et al. 2024

JAMA

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ImportanceThe accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5).ObjectiveTo assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5.Data Sources and Study SelectionThe databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition. Because diagnosis of alcohol use disorder does not include excessive alcohol use as a criterion, studies of screening tools that identify excessive or high-risk drinking among younger (aged 9-18 years), older (aged ≥65 years), and pregnant persons also were retained.Data Extraction and SynthesisSensitivity, specificity, and likelihood ratios (LRs) were calculated. When appropriate, a meta-analysis was performed to calculate a summary LR.ResultsOf 4303 identified studies, 35 were retained (N = 79 633). There were 11 691 individuals with alcohol use disorder or a history of excessive drinking. Across all age categories, a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT) increased the likelihood of alcohol use disorder (LR, 6.5 [95% CI, 3.9-11]). A positive screening result using AUDIT identified alcohol use disorder better among females (LR, 6.9 [95% CI, 3.9-12]) than among males (LR, 3.8 [95% CI, 2.6-5.5]) (P = .003). An AUDIT score of less than 8 reduced the likelihood of alcohol use disorder similarly for both males and females (LR, 0.33 [95% CI, 0.20-0.52]). The abbreviated AUDIT-Consumption (AUDIT-C) has sex-specific cutoff scores of 4 or greater for males and 3 or greater for females, but was less useful for identifying alcohol use disorder (males: LR, 1.8 [95% CI, 1.5-2.2]; females: LR, 2.0 [95% CI, 1.8-2.3]). The AUDIT-C appeared useful for identifying measures of excessive alcohol use in younger people (aged 9-18 years) and in those older than 60 years of age. For those younger than 18 years of age, the National Institute on Alcohol Abuse and Alcoholism age-specific drinking thresholds were helpful for assessing the likelihood of alcohol use disorder at the lowest risk threshold (LR, 0.15 [95% CI, 0.11-0.21]), at the moderate risk threshold (LR, 3.4 [95% CI, 2.8-4.1]), and at the highest risk threshold (LR, 15 [95% CI, 12-19]). Among persons who were pregnant and screened within 48 hours after delivery, an AUDIT score of 4 or greater identified those more likely to have alcohol use disorder (LR, 6.4 [95% CI, 5.1-8.0]), whereas scores of less than 2 for the Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down screening tool and the Tolerance, Annoyed, Cut-Down and Eye-Opener screening tool identified alcohol use disorder similarly (LR, 0.05 [95% CI, 0.01-0.20]).Conclusions and RelevanceThe AUDIT screening tool is useful to identify alcohol use disorder in adults and in individuals within 48 hours postpartum. The National Institute on Alcohol Abuse and Alcoholism youth screening tool is helpful to identify children and adolescents with alcohol use disorder. The AUDIT-C appears useful for identifying various measures of excessive alcohol use in young people and in older adults.

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Pharmacologic Treatment Initiation Among Medicare Beneficiaries Hospitalized With Alcohol Use Disorder

Cited by 11 publications

References 4 publications

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations

Sobering Perspectives on the Treatment of Alcohol Use Disorder

Does This Patient Have Alcohol Use Disorder?

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