Implementation of a Process for Initiating Naltrexone in Patients Hospitalized for Alcohol Detoxification or Withdrawal
John R. Stephens, MD, UNC Hospitals, Division of Hospital Medicine, 101 Manning Drive, CB#7085, Chapel Hill, NC 27599-7085; Telephone: 984-974-1931; Fax: 984-974-2216; E-mail: email@example.com
BACKGROUND: Naltrexone trials have demonstrated improved outcomes for patients with alcohol use disorders. Hospital initiation of naltrexone has had limited study.
OBJECTIVES: To describe the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal about naltrexone.
DESIGN: A pre-post study analysis.
SETTING: A tertiary academic center.
PATIENTS: Patients hospitalized for alcohol withdrawal.
INTERVENTIONS: (1) Provider education about the efficacy and contraindications of naltrexone and (2) algorithms for evaluating patients for naltrexone.
MEASUREMENTS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
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