Department of Medicine, Division of Hospital Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
J Hosp Med. 2018 Apr;13(4):221-228. doi: 10.12788/jhm.2900. Epub 2018 Jan 24.
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.
纳曲酮试验已证明可改善酒精使用障碍患者的预后。在医院开始使用纳曲酮的研究有限。
描述对住院酒精戒断患者进行纳曲酮咨询的实施过程及其影响。
一项前后研究分析。
一家三级学术中心。
因酒精戒断而住院的患者。
（1）教育提供者有关纳曲酮的疗效和禁忌症，以及（2）评估患者纳曲酮的算法。
在出院前接受纳曲酮咨询和处方的患者比例，以及干预前后 30 天内急诊部（ED）复诊和再住院的患者比例。
我们确定了实施前后各 128 例和 114 例患者的情况。接受纳曲酮咨询的患者比例从实施前的 1.6%上升到实施后的 63.2%（P<.001）；接受纳曲酮处方的患者比例从 1.6%上升到 28.1%（P<.001）。在未调整的情况下，比较干预前组和干预后组，30 天 ED 复诊率（25.8%比 19.3%；P=.23）或再住院率（10.2%比 11.4%；P=.75）没有差异。在调整了人口统计学和合并症后，干预后患者 30 天 ED 复诊的可能性较低（优势比[OR]为 0.47；95%置信区间[CI]为 0.24-0.94），但再住院率没有显著差异（OR=0.76；95%CI，0.30-1.92）。在亚组分析中，与未接受纳曲酮咨询的患者相比，接受纳曲酮咨询的患者 30 天 ED 复诊（9.7%比 35.7%；P=.001）和再住院（2.8%比 26.2%；P<.001）的可能性较低。
对住院酒精戒断患者进行纳曲酮咨询以维持清醒的过程的实施与 30 天内 ED 复诊率较低相关，但再住院率无统计学差异。
