Implementation of a Process for Initiating Naltrexone in Patients Hospitalized for Alcohol Detoxification or Withdrawal

TLDR

Naltrexone trials have shown improved outcomes for alcohol use disorder, yet hospital initiation of the medication has been understudied. The study aimed to describe the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal about naltrexone. The intervention combined provider education on naltrexone efficacy and contraindications with algorithms for patient evaluation, and was evaluated in a pre‑post analysis of 128 encounters before and 114 after implementation. Counseling increased from 1.6 % to 63.2 % and prescriptions from 1.6 % to 28.1 %, and the process was associated with a significant reduction in 30‑day ED revisits (adjusted OR = 0.47) but no statistically significant change in rehospitalizations.

Abstract

Naltrexone trials have demonstrated improved outcomes for patients with alcohol use disorders. Hospital initiation of naltrexone has had limited study.To describe the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal about naltrexone.A pre-post study analysis.A tertiary academic center.Patients hospitalized for alcohol withdrawal. (1) Provider education about the efficacy and contraindications of naltrexone and (2) algorithms for evaluating patients for naltrexone.The percentages of patients counseled about and prescribed naltrexone before discharge and the percentages of pre- and postintervention patients with 30-day emergency department (ED) revisits and rehospitalizations.We identified 128 patient encounters before and 114 after implementation. The percentage of patients counseled about naltrexone rose from 1.6% preimplementation to 63.2% postimplementation (P<.001); the percentage of patients prescribed naltrexone rose from 1.6% to 28.1% (P<.001). Comparing preintervention versus postintervention groups, there were no unadjusted differences in 30-day ED revisits (25.8% vs 19.3%; P=.23) or rehospitalizations (10.2% vs 11.4%; P=.75). When adjusted for demographics and comorbidities, postintervention patients had lower odds of 30-day ED revisits (odds ratio [OR]=0.47; 95% confidence interval [CI], 0.24-0.94) but no significant difference in rehospitalizations (OR=0.76; 95% CI, 0.30-1.92). In subgroup analysis, postintervention patients counseled versus those not counseled about naltrexone were less likely to have 30-day ED revisits (9.7% vs 35.7%; P=.001) and rehospitalizations (2.8% vs 26.2%; P<.001).The implementation of a process for counseling patients hospitalized for alcohol withdrawal about using naltrexone for the maintenance of sobriety was associated with lower 30-day ED revisits but no statistically significant difference in rehospitalizations.