Predictors of Newly Prescribed Medications for Alcohol Use Disorder Among Hospitalized Adults: A Retrospective Cohort Study.

BACKGROUND

Alcohol use disorder (AUD) is pervasive among hospitalized adults and associated with poor post-hospitalization outcomes. Medications for alcohol use disorder (MAUD) improve clinical outcomes, but prescribing rates at hospital discharge remain low. Factors associated with inpatient MAUD initiation are incompletely understood.

OBJECTIVE

Identification of patient-level and hospitalization-level factors associated with a new MAUD prescription at hospital discharge among adults with AUD.

DESIGN

Retrospective cohort study.

PATIENTS: Adults hospitalized with an AUD-related diagnosis between 2018 and 2023 at one of two hospitals within a large academic medical center without a dedicated inpatient addiction medicine consult service.

MAIN MEASURES/OUTCOMES: The primary outcome was a new prescription of an FDA-approved MAUD at hospital discharge. Predictor variables were patient and hospitalization characteristics. Associations were measured using multivariable analyses, with generalized estimating equations accounting for patients with multiple hospitalizations.

KEY

RESULTS

The cohort included 4232 hospitalizations among 2347 patients. New MAUD were prescribed at discharge in 467 hospitalizations (11%). In the multivariable analysis, a primary AUD diagnosis was the only patient-level factor associated with MAUD prescription (OR = 1.25; 95% CI 1.02-1.54). Hospitalization characteristics independently associated with MAUD prescription included longer length of stay (OR = 1.70 [1.33, 2.17], 1.47 [1.08, 2.02], and 1.37 [0.98, 1.91] for 3-4 days, 5-7 days, and 8 or more days relative to 0-2 days), consultation by care management (OR 1.37; 95% CI 1.02-1.85), and discharge from a general medicine teaching or family medicine service (OR = 1.41 [1.09, 1.83], and OR = 2.07 [1.52, 2.81]) respectively relative to HIM non-teaching team.

CONCLUSIONS

MAUD prescribing at hospital discharge remains low. However, several hospitalization-level factors were associated with higher prescribing rates, suggesting that service structure and consultative support may represent targets for interventions to improve evidence-based treatment of AUD.