Martin Marlene, Seraydarian Manuel, Gasper James, DeFries Triveni
Department of Medicine, San Francisco General Hospital, San Francisco, California, USA
Department of Medicine, University of California San Francisco, San Francisco, California, USA.
BMJ Open Qual. 2024 Dec 9;13(4):e003113. doi: 10.1136/bmjoq-2024-003113.
Only 1.9% of the individuals in the USA with alcohol use disorder (AUD) receive medication for AUD. Hospitalisation presents an opportunity to identify patients with AUD and offer treatment. Extended-release naltrexone (XR-NTX) is a Food and Drug Administration-approved medication for AUD that reduces drinking days and heavy drinking days. XR-NTX can reduce healthcare costs, decrease acute care utilisation and increase retention in treatment. We offered and initiated XR-NTX during hospitalisation to patients with moderate-to-severe AUD. We describe the follow-up rates for XR-NTX after hospital initiation and the reasons for XR-NTX discontinuation in the outpatient setting after hospital initiation. We performed a retrospective chart review of 62 hospitalised patients with moderate-to-severe AUD who received XR-NTX between 1 November 2019 and 31 December 2020. Twenty-two patients (35.5%) received ≥1 dose of XR-NTX within the first 3 months of discharge, 22 (35.5%) stopped XR-NTX and 18 (29.0%) did not follow-up. Overall, 44 (71.0%) patients followed up after discharge. Among those that discontinued XR-NTX, the most common reasons were: (1) a preference for oral NTX; (2) clinicians switching patients to oral NTX after patients missed an XR-NTX dose; (3) clinician challenges in prescribing XR-NTX; and (4) patient obstacles to accessing outpatient care. Our study highlights several opportunities to address modifiable reasons to improve access to and retention in XR-NTX treatment.
在美国，只有1.9%的酒精使用障碍（AUD）患者接受了AUD药物治疗。住院治疗为识别AUD患者并提供治疗提供了契机。缓释纳曲酮（XR-NTX）是一种经美国食品药品监督管理局批准用于治疗AUD的药物，可减少饮酒天数和重度饮酒天数。XR-NTX可降低医疗成本，减少急性护理的使用，并提高治疗的持续性。我们在住院期间为中重度AUD患者提供并启动了XR-NTX治疗。我们描述了住院启动XR-NTX治疗后的随访率，以及住院启动后门诊环境中停用XR-NTX的原因。我们对2019年11月1日至2020年12月31日期间接受XR-NTX治疗的62例中重度AUD住院患者进行了回顾性病历审查。22例患者（35.5%）在出院后的前3个月内接受了≥1剂XR-NTX治疗，22例（35.5%）停用了XR-NTX，18例（29.0%）未进行随访。总体而言，44例（71.0%）患者出院后进行了随访。在停用XR-NTX的患者中，最常见的原因是：（1）偏好口服纳曲酮；（2）患者错过XR-NTX剂量后临床医生将患者换用口服纳曲酮；（3）临床医生在开具XR-NTX处方时遇到困难；（4）患者在获得门诊护理方面存在障碍。我们的研究突出了几个解决可改变原因的机会，以改善XR-NTX治疗的可及性和持续性。
