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Interventions to Improve Outpatient Follow-up for Hospitalized Patients With Alcohol Use Disorder : A Systematic
Eden Y Bernstein1, Kelsey Hills-Dunlap2, Ariyani Challapalli3
1Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz, Aurora, Colorado (E.Y.B., V.C.).
Background:
Hospitalizations for alcohol use disorder (AUD) are common and morbid. Outpatient follow-up after discharge is critical for reducing alcohol use and subsequent readmissions, but effective interventions to support this transition are unknown.
Purpose:
To summarize evidence on the effectiveness of hospital-based interventions to improve outpatient follow-up for AUD.
Data Sources:
Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL (January 2000 to February 2025).
Study Selection:
Two authors independently reviewed abstracts and full-text articles to identify hospital-based trials and cohort studies that evaluated interventions to improve outpatient AUD follow-up versus usual care or an active comparator.
Data Extraction:
Study data were extracted by 2 authors using a standardized template. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Data Synthesis:
Seventeen studies of 21 interventions (12 randomized clinical trials [RCTs] [n = 1917], 3 nonrandomized trials [n = 459], and 2 cohort studies [n = 9974]) were included. Interventions were heterogeneous, and most (85%) included several components: behavioral (76%), care coordination (76%), medication management (14%), and social support (33%). Eight interventions (38%) reported improved linkage to outpatient follow-up. Effective interventions generally combined behavioral and care coordination with AUD medications or social support. Effect sizes across RCTs ranged from an 8% absolute decrease to a 30% absolute increase in outpatient follow-up. The certainty of evidence was low due to the high risk of bias and imprecision of results.
Limitation:
Only English-language publications were included.
Conclusion:
Few intervention studies of low certainty improved posthospitalization follow-up for patients with AUD. Given the substantial morbidity associated with untreated AUD, high-quality RCTs testing various components of interventions are needed.
Primary Funding Source:
None. (PROSPERO: CRD42025636943).
