Study Highlights Underuse of Medications for Alcohol Use Disorder in Acute Care Settings

New research has revealed a significant gap in prescribing of effective medications for alcohol use disorder (AUD). The study, reported in Alcoholism: Clinical and Experimental Research, showed that just one in twenty patients with an alcohol-related diagnosis were prescribed an approved AUD drug (naltrexone, disulfiram, or acamprosate). The findings reinforce and build on previous evidence of under-prescribing, despite these treatments being proven to reduce heavy drinking and relapse. In the inpatient acute care setting, provision of AUD medication has been shown to be both feasible and associated with a reduction in re-admissions and emergency department (ED) visits. However, few prior studies had reported on prescribing habits in this setting. The current study examined prescribing in the acute inpatient care setting compared to other care settings within the University of Colorado Healthcare System.

The researchers evaluated electronic health record (EHR) data from adult patients with an alcohol-related diagnosis between 2016 and 2019, before COVID-19 disrupted alcohol treatment protocols and healthcare access. Patients with a diagnosis for opioid use disorder were excluded from the analysis. Prescriptions for AUD medications were identified from pharmacy records in patients’ EHRs, and statistical modelling was conducted to identify factors associated with higher or lower rates of prescribing.

In total, over 48,000 patients with over 136,000 alcohol-related encounters were identified. Encounters were most common in the ED (42%), followed by inpatient acute care (17%), inpatient substance use treatment (18%), and outpatient primary care (12%) settings. Across all settings, only 5% of patients received AUD medication, and in certain settings prescribing rates were much lower. Female sex and addiction medicine consults were positively associated with AUD medication prescriptions. In contrast, negative predictors of prescribing were alcohol encounters in the ED, inpatient acute care, or ICU settings (compared to inpatient alcohol treatment settings), Hispanic ethnicity, and black or non-white race. The odds of receiving a prescription were 93% lower during acute care AUD hospitalizations than during inpatient substance use treatment for alcohol use (i.e. inpatient rehab).

Therefore, although alcohol-related hospital encounters were common, prescriptions for AUD medication were infrequent, including in the inpatient acute care hospital setting and the ED. The researchers comment that, although 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. Prescribing rates in acute care settings may benefit from greater involvement of addiction medicine consultation or inpatient substance use expertise (provided in only 0.6% of encounters in this study). Education for hospitalists, intensivists and generalists to increase their familiarity with AUD medications and their use in high-risk populations would also be of value. Further studies are needed to evaluate the most feasible methods to provide AUD medication for hospitalized patients with alcohol-related encounters in an equitable way.

Medications for alcohol use disorders during alcohol-related encounters in a Colorado regional healthcare system. L. Chockalingam, E. L. Burnham, S. E. Jolley (pages xxx)

ACER-21-5142.R1