Title Association of prescribing medications for alcohol use disorder at hospital discharge and subsequent refills with rates of readmission in alcohol use disorder
Authors Amanda Owens, PharmD, Nadia Jubran, PharmD, MS, BCACP
Learning ObjectiveAudience members will be able to evaluate the impact of access to medications for alcohol use disorder (MAUD) at hospital discharge on 90-day hospital readmission rates in veterans with a primary diagnosis related to alcohol use disorder (AUD) at the DC Veterans Affairs Medical Center and identify strategies to improve this access to potentially reduce readmission rates.
Background/Objective Evaluate the impact of access to medications for alcohol use disorder (MAUD) at hospital discharge on 90-day hospital readmission rates in veterans with a primary diagnosis related to AUD at the DC Veterans Affairs Medical Center.
Methods This retrospective chart review will investigate veterans with an AUD-related primary diagnosis code admitted between June 1, 2024, and June 30, 2025, focusing on those prescribed or not prescribed oral naltrexone, topiramate, acamprosate, or disulfiram at discharge, using VA Corporate Data Warehouse data. Inclusion criteria: veterans aged ≥21 years, admitted with an AUD diagnosis. Exclusion criteria: those receiving IM naltrexone, hospice care 6 months prior, or pregnant/breastfeeding. Primary outcome: compare 90-day hospital readmission rates related to AUD between medication-receiving and non-receiving veterans. Secondary outcomes: initial outpatient visit attendance and comparing readmission rates based on medication refills and supply days. A chi-square test will be used for statistical analysis.
Results A total of 231 admissions were analyzed, with an age range of 23 to 80 years (mean 53.52, SD 12.37). The majority were male (211, 91.3%) and black/African American (120, 51.9%). Average AST/ALT on admission were 72/45, and on discharge 63/48. Most patients did not receive MAUD at discharge (158, 68.4%). Oral naltrexone was the most prescribed MAUD (54, 23.4%). The mean days lapse since admission was 69.84 (SD 57.09). MAUD prescribed 90 days prior to admission included naltrexone for 11 (4.8%). Statistically significant differences were found in reducing 90-day hospital readmission rates for AUD when MAUD were prescribed at discharge (p<0.001) as well as having an active refill of MAUD at discharge (p<0.001).
Conclusions The study found a notable under-prescription of MAUD at discharge. Prescribing MAUD at discharge significantly reduced hospital readmission rates for AUD (p<0.001). Having access to a refill demonstrated a protective effect (p<0.001). However, the number of refills and day’s supply were not statistically significant in reducing readmissions. This study illustrates the importance of prescribing MAUD at discharge along with available refills. Limitations include incomplete lab values and inconsistencies in follow-up visit data. Future efforts should focus on improving MAUD prescription rates and ensuring access to refills.
Self-Assessment Question(T/F) Prescribing medications for alcohol use disorder (MAUD) is associated with the reduction of hospital readmissions for AUD.
