Skip to main content

Advertisement

Log in

An Inpatient Treatment and Discharge Planning Protocol for Alcohol Dependence: Efficacy in Reducing 30-Day Readmissions and Emergency Department Visits

  • Innovation and Improvement: Innovations in Medical Education
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

BACKGROUND

Alcohol dependence results in multiple hospital readmissions, but no discharge planning protocol has been studied to improve outcomes. The inpatient setting is a frequently missed opportunity to discuss treatment of alcohol dependence and initiate medication-assisted treatment, which is effective yet rarely utilized.

AIM

Our aim was to implement and evaluate a discharge planning protocol for patients admitted with alcohol dependence.

SETTING

The study took place at the San Francisco General Hospital (SFGH), a university-affiliated, large urban county hospital.

PARTICIPANTS

Learner participants included Internal Medicine residents at the University of California, San Francisco (UCSF) who staff the teaching service at SFGH. Patient participants included inpatients with alcohol dependence admitted to the Internal Medicine teaching service.

PROGRAM DESCRIPTION

We developed and implemented a discharge planning protocol for patients admitted with alcohol dependence that included eligibility assessment and initiation of medication-assisted treatment.

PROGRAM EVALUATION

Rates of medication-assisted treatment increased from 0 % to 64 % (p value < 0.001). All-cause 30-day readmission rates to SFGH decreased from 23.4 % to 8.2 % (p value = 0.042). All-cause emergency department visits to SFGH within 30 days of discharge decreased from 18.8 % to 6.1 % (p value = 0.056).

DISCUSSION

Through implementation of a discharge planning protocol by Internal Medicine residents for patients admitted with alcohol dependence, there was a statistically significant increase in medication-assisted treatment and a statistically significant decrease in both 30-day readmission rates and emergency department visits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

REFERENCES

  1. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2012.

    Google Scholar 

  2. Amarasingham R, Patel PC, Toto K, et al. Allocating scarce resources in real-time to reduce heart failure readmissions: a prospective, controlled study. BMJ Qual Saf. 2013;22(12):998–1005.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ryan J, Kang S, Dolacky S, Ingrassia J, Ganeshan R. Change in readmissions and follow-up visits as part of a heart failure readmission quality improvement initiative. Am J Med. 2013;126(11):989–994.

    Article  PubMed  Google Scholar 

  4. Lainscak M, Kadivec S, Kosnik M, et al. Discharge coordinator intervention prevents hospitalizations in patients with COPD: a randomized controlled trial. J Am Med Dir Assoc. 2013;14(6):450e1–6.

    Article  Google Scholar 

  5. Hopkinson NS, Englebretsen C, Cooley N, et al. Designing and implementing a COPD discharge care bundle. Thorax. 2012;67(1):90–2.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Chen JY, Ma Q, Chen H, Yermilov I. New bundled world: quality of care and readmission in diabetes patients. J Diabetes Sci Technol. 2012;6(3):563–71.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Healy SJ, Black D, Harris C, Lorenz A, Dungan KM. Inpatient diabetes education is associated with less frequent hospital readmission among patients with poor glycemic control. Diabetes Care. 2013;36(10):2960–7.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Stewart S, Swain S. Assessment and management of alcohol dependence and withdrawal in the acute hospital. Clin Med. 2012;12(3):266–71.

    Article  PubMed  Google Scholar 

  9. Weiss RD, Kueppenbender KD. Combining psychosocial treatment with pharmacotherapy for alcohol dependence. J Clin Psychopharmacol. 2006;26(Suppl 1):S37–S42.

    Article  PubMed  Google Scholar 

  10. Garbutt JC, West SL, Carey TS, Lohr KN, Crews FT. Pharmacological treatment of alcohol dependence. JAMA. 1999;281:1318–25.

    Article  CAS  PubMed  Google Scholar 

  11. O'Malley SS, Kosten TR. Pharmacotherapy of addictive disorders. In: Miller WR, Carroll KM, eds. Rethinking substance abuse: what the science shows, and what we should do about it. New York: The Guilford Press; 2006:240–56.

    Google Scholar 

  12. Kranzler HR, Van Kirk J. Efficacy of naltrexone and acamprosate for alcoholism treatment: a meta-analysis. Alcohol Clin Exp Res. 2001;25:1335–41.

    Article  CAS  PubMed  Google Scholar 

  13. Srisurapanont M, Jarusuraisin N. Opioid antagonists for alcohol dependence (Review). Cochrane Database Syst Rev. 2005;2(1), CD001867.

    Google Scholar 

  14. Streeton C, Whelan G. Naltrexone: a relapse prevention maintenance treatment of alcohol dependence: a meta-analysis of randomized controlled trials. Alcohol. 2001;36:544–52.

  15. Pettinati HM, O’Brien CP, Rabinowitz AR, et al. The status of naltrexone in the treatment of alcohol dependence: specific effects on heavy drinking. J Clin Psychopharmacol. 2006;26(6):610–25.

    Article  CAS  PubMed  Google Scholar 

  16. Anton RF, O’Malley SS, Ciraulo DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–17.

    Article  CAS  PubMed  Google Scholar 

  17. Jones DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889–900.

    Article  Google Scholar 

  18. Mason BJ. Treatment of alcohol-dependent outpatients with acamprosate: a clinical review. J Clin Psychiatry. 2001;62(Suppl 10):42–8.

    CAS  PubMed  Google Scholar 

  19. Soyka M, Chick J. Use of acamprosate and opioid agonists in the treatment of alcohol dependence: a European perspective. Am J Addict. 2003;12(Suppl 1):S69–S80.

    Article  PubMed  Google Scholar 

  20. Yahn SL, Watterson LR, Olive MF. Safety and efficacy of acamprosate for the treatment of alcohol dependence. Subst Abus. 2013;6:1–12.

    Google Scholar 

  21. Rösner S, Hackl-Herrwerth A, Leucht S, Lehert P, Vecchi S, Soyka M. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010;9:1–118.

    Google Scholar 

  22. Suh JJ, Pettinati HM, Kampman KM, O’Brien CP. The status of disulfiram: a half of a century later. J Clin Psychopharmacol. 2006;26(3):290–302.

    Article  CAS  PubMed  Google Scholar 

  23. Jorgensen CH, Pederson B, Tonnesen H. The efficacy of disulfiram for the treatment of alcohol use disorder. Alcohol Clin Exp Res. 2011;35(10):1749–58.

    Article  CAS  PubMed  Google Scholar 

  24. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Incorporating Alcohol Pharmacotherapies Into Medical Practice, Treatment Improvement Protocol (TIP) Series, No. 49. Rockville, MD: Center for Substance Abuse Treatment; 2009.

    Google Scholar 

  25. Anton R. Naltrexone for the management of alcohol dependence. N Engl J Med. 2008;359(7):715–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Friedmann PD. Alcohol use in adults. N Engl J Med. 2013;368(4):365–73.

    Article  CAS  PubMed  Google Scholar 

  27. Petrakis IL, Leslie D, Rosenheck R. Use of naltrexone in the treatment of alcoholism nationally in the Department of Veterans Affairs. Alcohol Clin Exp Res. 2003;27:1780–4.

    Article  CAS  PubMed  Google Scholar 

  28. Mark TL, Kranzle HR, Song X. Understanding U.S. addiction physicians’ low rate of naltrexone prescription. Drug Alcohol Depend. 2003;71(3):219–228.

    Article  PubMed  Google Scholar 

  29. Stewart SH, Connors GJ. Interest in pharmacotherapy and primary care alcoholism treatment among medically hospitalized, alcohol dependent patients. J Addict Dis. 2007;26(2):63–69.

    Article  PubMed  Google Scholar 

  30. Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30.

    Article  PubMed  Google Scholar 

  31. Davoudi M, Rawson RA, Davoudi M, Rawson RA. Screening, brief intervention, and referral to treatment (SBIRT) initiatives in California: notable trends, challenges, and recommendations. J Psychoactive Drugs. 2010;Suppl 6:239–48.

    Article  PubMed  Google Scholar 

  32. Hettema JE, Ratanawongsa N, Manuel JK, et al. A SBIRT curriculum for medical residents: development of a performance feedback tool to build learner confidence. Subst Abus. 2012;33(3):241–50.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the University of California, San Francisco Internal Medicine residents for their participation. We would also like to thank Jenee Bryant, MSW, Katie Luttrell, MSW, Amy Logan, Pharm.D., David Hersh, MD, Paula Lum, MD, and Richard Brooks, MD for their support throughout this project.

Funders

None.

Prior Presentations

We presented an earlier version of the manuscript as a poster for the University of California, San Francisco Quality and Safety Symposium on 29 May 2012. This abstract was also presented for the Association of Medical Education and Research in Substance Abuse (AMERSA) conference on 3 November 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennie Wei MD, MPH.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 28 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wei, J., Defries, T., Lozada, M. et al. An Inpatient Treatment and Discharge Planning Protocol for Alcohol Dependence: Efficacy in Reducing 30-Day Readmissions and Emergency Department Visits. J GEN INTERN MED 30, 365–370 (2015). https://doi.org/10.1007/s11606-014-2968-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-014-2968-9

KEY WORDS

Navigation