Kirchoff Robert W, Mohammed Norhan M, McHugh Jack, Markota Matej, Kingsley Thomas, Leung Jonathan, Burton M Caroline, Chaudhary Rahul
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
Mayo Clin Proc Innov Qual Outcomes. 2021 Apr 8;5(2):495-501. doi: 10.1016/j.mayocpiqo.2021.01.013. eCollection 2021 Apr.
Alcohol use disorder (AUD) is a highly prevalent health issue in the United States. The number of those receiving medication-assisted treatment (MAT) is limited, despite strong evidence for their effectiveness. The inpatient setting may represent an important opportunity to initiate MAT. The goal of this study was to summarize the data on initiation in the emergency department or inpatient setting for the management of AUDs. We searched ClinicalTrials.gov, Ovid EBM Reviews, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science from inception through October 31, 2019. Search strategies were created using a combination of keywords (Supplemental Appendix 1, available online at http://www.mcpiqojournal.org) and standardized index terms related to naltrexone therapy for medically hospitalized patients with AUD. Two uncontrolled pre-post study designs evaluated naltrexone prescription rates, 30-day readmission rates, and rehospitalization rates. Two authors independently abstracted data on study characteristics, results, and study-level risk of bias. The research team collaborated to assess the strength of evidence across studies. Two studies reported that implementing a protocol for naltrexone initiation increased MAT rates, with one study noting a substantial decrease in 30-day hospital readmissions. Overall, we found that there is a paucity of data on naltrexone initiation in the inpatient setting for AUDs. This likely reflects the nature of current clinical practice and prescriber comfortability. There is a need for further studies evaluating MAT initiation in the inpatient setting. Furthermore, efforts to increase provider knowledge of these therapeutic options are in need of further exploration.
酒精使用障碍（AUD）在美国是一个高度普遍的健康问题。尽管有充分证据证明药物辅助治疗（MAT）的有效性，但接受此类治疗的人数仍然有限。住院环境可能是启动MAT的一个重要契机。本研究的目的是总结在急诊科或住院环境中启动AUD管理的相关数据。我们检索了ClinicalTrials.gov、Ovid循证医学综述、Ovid Embase、Ovid Medline、Ovid PsycINFO、Scopus和Web of Science数据库，检索时间从建库至2019年10月31日。检索策略是通过结合关键词（补充附录1，可在http://www.mcpiqojournal.org在线获取）以及与纳曲酮治疗AUD住院患者相关的标准化索引词制定的。两项非对照的前后研究设计评估了纳曲酮的处方率、30天再入院率和再住院率。两名作者独立提取了关于研究特征、结果和研究水平偏倚风险的数据。研究团队合作评估了各项研究的证据强度。两项研究报告称，实施纳曲酮启动方案可提高MAT率，其中一项研究指出30天医院再入院率大幅下降。总体而言，我们发现关于AUD住院患者启动纳曲酮治疗的数据匮乏。这可能反映了当前临床实践的性质以及开处方者的舒适度。需要进一步开展研究评估住院环境中的MAT启动情况。此外，还需要进一步探索提高医疗服务提供者对这些治疗选择认识的方法。
