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Inpatient Screening, Brief Intervention, and Referral to Treatment for Alcohol Use Disorder in Patients Admitted with
1McMaster University Adult Gastroenterology Residency Program, Hamilton, ON, Canada.
Insights
Screening, brief intervention, and referral to treatment (SBIRT) for alcohol use disorder was underutilized in patients with alcohol-related liver disease. Inpatient SBIRT reduced 30- and 90-day readmissions for alcohol-associated hepatitis but not for decompensated alcohol-related cirrhosis.
Area of Science:
- Hepatology
- Addiction Medicine
- Public Health
Background:
- Alcohol-related liver disease management necessitates addressing alcohol use disorder (AUD).
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a key intervention for AUD.
- The effectiveness of inpatient SBIRT for patients with alcohol-associated hepatitis (AAH) or decompensated alcohol-related cirrhosis (DARLC) requires investigation.
Purpose of the Study:
- To determine the proportion of actively drinking patients admitted for AAH or DARLC who received SBIRT during their hospital stay.
- To assess if inpatient SBIRT is associated with reduced readmissions for alcohol-related liver disease.
Main Methods:
- Retrospective cohort study of actively drinking patients admitted with AAH or DARLC between January 2017 and December 2021.
- Logistic regression analysis to identify factors associated with 30-day and 90-day readmissions.
- Evaluation of SBIRT delivery rates and its association with readmission outcomes.
Main Results:
- SBIRT was administered in 51.7% of AAH admissions and 23.7% of DARLC admissions.
- For AAH, inpatient SBIRT was significantly associated with reduced 30-day (OR 0.098) and 90-day (OR 0.166) readmissions.
- No significant association was found between SBIRT and 30-day or 90-day readmissions for DARLC.
Conclusions:
- Inpatient SBIRT is underutilized in patients hospitalized for AAH and DARLC.
- Inpatient SBIRT demonstrates a significant benefit in reducing short-term readmissions for patients with AAH.
- Further research is needed to optimize SBIRT delivery and impact for DARLC patients.
Introduction:
The management of alcohol-related liver disease requires a multidisciplinary approach to treat alcohol use disorder. We aimed to determine the proportion of actively drinking patients admitted for alcohol-associated hepatitis (AAH) or decompensated alcohol-related cirrhosis (DARLC) who were offered or underwent screening, brief intervention, and referral to treatment (SBIRT) for alcohol use disorder during admission and if inpatient SBIRT is associated with reduced readmissions for alcohol-related liver disease.
Methods:
We conducted a retrospective cohort study of actively drinking patients admitted to our institution from January 2017 to December 2021 with AAH or DARLC. Logistic regression was used to identify factors, such as conducting SBIRT, that were associated with 30-day and 90-day readmissions for recurrent AAH or DARLC.
Results:
There were 120 AAH admissions (mean age 47.7 ± 13.6 years), and 177 DARLC admissions (mean age 58.2 ± 9.5 years). SBIRT was conducted in only 51.7% of AAH admissions, and 23.7% of DARLC admissions. For AAH, conducting SBIRT was associated with significantly reduced 30-day (OR 0.098, P = 0.001, 95% CI 0.024-0.408) and 90-day (OR 0.166, P = 0.003, 95% CI 0.052-0.534) readmissions. For DARLC, there was no association between conducting SBIRT and 30-day or 90-day readmissions.
Conclusion:
SBIRT was conducted with actively drinking patients in only 51.7% of AAH admissions and 23.7% of DARLC admissions. Patients admitted for AAH who received inpatient SBIRT had decreased 30-day and 90-day readmission rates for AAH or DARLC.
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