Background: Alcohol withdrawal is a common reason for admission to acute care hospitals. The American Society of Addiction Medicine (ASAM) has proposed that prescription of medications for alcohol use disorder (AUD) and timely outpatient follow-up are important quality measures for inpatient detoxification, but few studies report the frequency of AUD medications and subsequent follow-up for patients discharged after inpatient detoxification.
Methods: We conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 Veteran Health Administration (VHA) hospitals between October 1, 2018, and September 30, 2019. Demographic and comorbidity data were obtained from the VHA’s corporate data warehouse. Medications for AUD, outpatient referrals, and post-discharge outcomes were obtained by chart review. Factors associated with all-cause 30-day readmission and 6-month sobriety were examined using logistic regression.
Results: Of the 594 patients included in this study, 50.7% were prescribed medications for AUD at the time of discharge, including gabapentin (29.8%), naltrexone (26.3%), and acamprosate (5.7%). Overall, 78.5% of patients were discharged with post-discharge follow-up, including 59.4% with a primary care appointment, 42.8% with an outpatient substance abuse office appointment, 32.9% with an outpatient substance abuse program appointment, and 12.5% who were discharged to a residential substance abuse program. The 30-day readmission rate was 25.5% and the 6-month sobriety rate was 21.1%. In multivariable analysis, factors significantly associated with increased 30-day readmission rate included co-occurring non-alcohol substance use disorder (AOR 2.07, 95% CI 1.31-3.25), Charlson comorbidity index (AOR 1.11, 95% CI 1.01-1.22), number of prior admissions in the past year (AOR 1.13, 95% CI 1.02-1.25), and discharge “against medical advice” (AOR 2.26, 95% CI 1.17-4.38). Discharge to residential treatment program (AOR 0.43, 95% CI 0.20-0.91) was associated with decreased readmission rate. Factors significantly associated with decreased 6-month sobriety included number of prior admissions (AOR 0.73, 95% CI 0.59-0.89) and discharge “against medical advice” (AOR 0.12, 95% CI 0.02-0.93). Discharge to residential substance abuse program was associated with increased 6-month sobriety (AOR 2.40, 95% CI 1.25-4.60). Medications for AUD were not associated with 30-day readmission or 6-month sobriety.
Conclusions: Readmission and return to heavy alcohol use are common for patients discharged from alcohol detoxification. In our study, medications for AUD at discharge were not associated with improved outcomes. The one modifiable factor at the time of discharge that improved AUD outcomes was discharge to residential treatment programs, which was associated with decreased readmission and improved rates of sobriety. Healthcare systems should provide residential treatment programs when possible and encourage patients to use these services after hospital discharge.
