2026 Eastern States Conference

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 Objective
Audience 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.

• True
• False

Title: Evaluating the Impact of Targeted Medication Review on Anticholinergic Medication Prescribing in Patients with Psychosis

Authors: Eva Shkreta, PharmD; Rebecca Bourgery, PharmD, BCPP, BCPS; Caralyn Granato, PharmD, BCPP, BCPS

Presentation objective (for CE credit): At the conclusion of my presentation, audience members will be able to describe the impact of anticholinergic burden in patients with psychosis. 

Self-assessment question: What is the clinical significance of anticholinergic burden in patients with psychosis? 

1. Blocks absorption of atypical antipsychotics
2. Significantly increases risk of cognitive impairment 
3. Main cause of tardive dyskinesia
4. Primary driver of metabolic syndrome

Background:
This project aims to reduce anticholinergic burden (ACB) in patients with psychosis followed by the Health Integration Program (HIP), a specialty team serving patients with psychotic disorders, through targeted medication reviews (TMR).

Methods:
Behavioral health ambulatory care pharmacists completed a TMR for all patients 18 years and older who are served by the HIP team at Cambridge Health Alliance (CHA). TMRs included a review of all anticholinergic medications the patient was prescribed, ACB score, and recommendations for potential deprescribing. A retrospective chart review was conducted at least three months after TMRs were completed. Patients not engaged with a HIP team prescriber or who were hospitalized at the time of chart review were excluded. Primary outcomes included the change in average number of anticholinergic medications and average ACB score after the TMR. Secondary outcomes included anticholinergic prescribing patterns to identify opportunities for intervention, subgroup analyses, and the number of referrals to behavioral health ambulatory care pharmacists. Subgroup analyses to include patients aged 65 years and older, prescribed clozapine, and the use of two or more high-risk anticholinergic medications.

Results: 
A total of 215 TMRs were completed and 206 met the inclusion criteria at the time of data collection. The average ACB score increased by 0.14 from 4.21 three months after the TMRs, with a decrease observed in 8.7% of patients. The average number of medications with ACB increased by 0.06 from 2.52 per patient, and 7.8% of patients had fewer anticholinergic medications. 

TMRs led to 42 medication changes, including 20 discontinuations and 22 dose reductions. Additionally, TMRs resulted in 7 new referrals to ambulatory behavioral health pharmacists. Among this patient group, the anticholinergic medications most frequently prescribed were clozapine, followed by olanzapine, benztropine and quetiapine.

Conclusion: 
Following TMR completion, both average ACB score and number of ACB medications increased. Based on these results, TMRs may not be the most effective tool to reduce anticholinergic burden. Finding alternative interventions to reduce anticholinergic burden is especially critical for patients with psychosis.

• Title: Effects of long-acting injectable antipsychotics on likelihood of inpatient psychiatric readmission within 90 days
• Authors: Erin M. Seddon, PharmD; Autumn Peck, PharmD, MBA; Stephen Kazmer, PharmD; Anna Marie Fink, PharmD.  
• Objective: Audience members will be able to assess the benefits of Long-Acting Injectable Antipsychotics on readmission rates compared to oral antipsychotics.
• Self-Assessment Question: This study showed a statistically significant difference in readmission rates between those prescribed a long-acting injectable antipsychotic vs those prescribed an oral only regimen (True or False)  
• Methods: A retrospective chart review of patients meeting inclusion criteria was conducted to determine the rate of 90-day readmission, with data collected from August 1, 2022, until July 31, 2025; included patients were at least 18 years of age and had an index psychiatric admission lasting at least 5 days. Patients were excluded if the long-acting injectable received was intramuscular naltrexone, had a sole diagnosis of any substance use disorder, and/or a diagnosis of dementia or a dementia related disorder. The primary outcome of 90-day psychiatric readmission was analyzed using a Chi-Square test for large sample nominal data. Secondary outcomes (ED presentation within 90 days; differences in rate of ED presentation or admission between LAIAs) were evaluated using an unpaired T-test to normal distribution interval/ratio data. Baseline characteristics and other confounding variables were compared between groups and evaluated using descriptive statistics.
• Results: Investigators observed a lower rate of 90-day psychiatric readmissions in patients prescribed a LAIA vs. those prescribed an oral only regimen, with readmission rates of 20% vs. 24%, (p=0.629).  Mean time to readmission was observed to be lower in the LAIA group (22 days) vs the oral only group (37 days), showing a shorter time to readmission in those prescribed a LAIA. Of the six LAIA studied, four agents were found to have associated readmissions, with Abilify Maintena and Uzedy having no associated readmissions. A lower rate of 90-day ED presentations was seen in the LAIA group vs the oral group with rates of 10% vs 12% respectively, (p= 0.749). Mean time to ED presentation was observed to be 17 days in both groups
• Conclusion: Investigators saw a non-statistically significant lower rate of 90-day readmissions and ED presentations with LAIAs. Two of the LAIA studied had no readmissions. Further research is needed regarding the incidence of 90-day readmissions between LAIA and oral only regimens, as well as the impact of demographic factors on readmission. Widespread education on the benefits of LAIAs is indicated to allow for less prescriber hesitation and generate greater evidence for future studies.