Study Finds Limited Evidence for Helping Hospitalized Patients With Alcohol Use Disorder Connect to Follow-Up Care

A systematic review by researchers at the University of Colorado Anschutz and Yale University found limited evidence that hospital-based interventions can help people with alcohol use disorder connect with outpatient treatment after they leave the hospital.

Researchers reviewed 17 studies involving nearly 12,400 patients and 21 interventions designed to improve engagement with treatment following hospitalization. Eight interventions showed evidence of improving outpatient treatment engagement, but the overall certainty of the evidence was very low, making it difficult to determine which approaches work best.

“It can feel like a revolving door,” said lead author Eden Bernstein, MD, MPH, assistant professor of Hospital Medicine at CU Anschutz. “We see people coming in with liver disease or pancreatitis who get better but are not connected to outpatient treatment after they leave, so they end up back in the hospital. The question is: What can hospitals do to connect patients to treatment?”

The study was published today in the Annals of Internal Medicine.

The senior author is Vineet Chopra, MD, MSc, professor of Hospital Medicine at CU Anschutz School of Medicine.

Alcohol use disorder, or AUD, affects about one in 10 U.S. adults and is associated with significant health consequences. Alcohol contributes to nearly 180,000 deaths in the United States each year. Yet fewer than half of hospitalized patients with AUD receive timely outpatient follow-up, and only about 7% of U.S. adults with AUD receive evidence-based treatment.

“Hospitalization can be an important opportunity to engage people with alcohol use disorder in treatment, but we don’t yet have a clear answer about the best way to make sure that connection continues after discharge,” Bernstein said.

What the researchers found

The review included 12 randomized clinical trials, three non-randomized trials and two cohort studies, conducted primarily in the United States.

The interventions varied widely. Most combined several approaches, including:

• Behavioral support, such as motivational interviewing and education.
• Care coordination, including discharge planning, communication with outpatient providers, patient outreach and care navigation.
• Medications for AUD.
• Social support, including peer or family involvement.

Eight interventions showed evidence of improving connection to outpatient treatment. Among the randomized clinical trials, the effects ranged from an 8% absolute decrease in follow-up to a 30% absolute increase.

The interventions that appeared most promising generally combined behavioral strategies and care coordination with medications for AUD or social support. Several also maintained contact with patients after discharge through telephone calls, appointment reminders or assistance navigating outpatient care.

But researchers caution that these findings do not establish that any particular intervention is effective.

“There were so many differences between the studies and outcomes that it’s hard to draw definitive conclusions,” Bernstein said.

Ten of the 12 randomized clinical trials were considered to have a high risk of bias, and researchers rated the overall certainty of the evidence as very low. The studies also differed substantially in their patient populations, interventions and methods for measuring follow-up.

“We found some encouraging signals, but the evidence is not strong enough to tell clinicians that one particular intervention is the answer,” Bernstein said. “The contrast between how common these hospitalizations are and how little we know about how to help these patients is alarming. We need better-designed studies to determine which components are actually necessary to help patients successfully transition from hospital care to ongoing treatment.”

Improving the transition from hospital to treatment

The researchers say future studies should identify which components of hospital-based interventions are most effective, including behavioral support, care coordination, medications for AUD and peer or family support.

“Getting patients through the hospital door is only the beginning,” Bernstein said. “We need to do a better job of making sure they have a clear path to continued treatment after they leave.”

Key Points

• A CU Anschutz review of 17 studies found limited evidence that hospital-based interventions improve connection to outpatient treatment for people with alcohol use disorder.
• Interventions combining behavioral support, care coordination, medications and social support showed the most encouraging results.
• Because the evidence was very low certainty, researchers say better studies are needed to identify which approaches best help patients continue treatment after leaving the hospital.