Impact of hospital-administered extended-release naltrexone on readmission rates for patients with alcohol use disorder.

BACKGROUND AND AIMS: Alcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in-hospital extended-release naltrexone (XR-NTX) administration on alcohol-related outcomes. METHODS: This retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR-NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR-NTX administration to identify number of alcohol-related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations. RESULTS: There was a significant decrease in ED visits and length of hospital stay post XR-NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle-aged, male and white patient population. CONCLUSIONS: In-hospital initiation of XR-NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in-hospital XR-NTX, emphasising the need for further research to establish causal relationships, assess cost-effectiveness and explore effectiveness across diverse patient populations. Effective in-hospital interventions, such as XR-NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.

Rapid growth in the COVID-19 era.

ABSTRACT: From Operation Warp Speed to the lipid mRNA vaccine, the COVID-19 pandemic has been a watershed moment for technological development, production, and implementation. The scale and pace of innovation and global collaboration has likely not been experienced since World War II. This article highlights some of the engineering accomplishments that occurred during the pandemic. We provide a broad overview of the technological achievements in vaccine design, antibody engineering, drug repurposing, and rapid diagnostic testing. We also discuss what the future of these technologies and the future of large-scale collaborations might look like moving forward.

Implementation of a Naloxone Best Practice Advisory Into an Electronic Health Record.

OBJECTIVES: Naloxone is a harm reduction tool for mitigating the rising rate of opioid overdose deaths. We sought to develop and implement an alert in the electronic health record outlining which patients are at higher risk of opioid overdose and should be coprescribed naloxone. Our aim was to increase coprescribing of naloxone to qualified patients. We also endeavored to evaluate naloxone prescription volume, fill rates, and statewide dispenses before and after alert implementation. METHODS: We developed the electronic alert according to a state opioid safety initiative specifying under which conditions it should activate. We collected data on naloxone prescriptions ordered in the 5 months before and after alert implementation and unique patients with a naloxone dispense statewide. We used internal pharmacy data to evaluate the percentage of fills and used a χ 2 test to assess changes in percentage of fills. We used descriptive statistics and t tests to analyze changes in the number of prescriptions and changes in unique patients dispensed naloxone. RESULTS: We found a 2144% increase in the number of monthly naloxone prescriptions written after the alert became active. There was no statistically significant change in the percentage of fills. There was a 402.8% increase in unique patients statewide with a naloxone dispense after alert implementation. CONCLUSIONS: Designing and implementing an electronic alert prompting naloxone coprescription are feasible and were associated with substantial increases in numbers of naloxone prescriptions and patients with naloxone dispenses statewide. Our findings expand on prior literature about electronic decision support for naloxone coprescription.

Impact of Hospital-Administered Extended-Release Naltrexone on Readmission Rates in Patients With Alcohol Use Disorder: A Pilot Study.

Objective: To evaluate the impact of extended-release (ER) intramuscular naltrexone on readmission rates for hospitalized patients with alcohol use disorder (AUD).Methods: This was a single-center, retrospective before and after study. Adult patients with AUD who received ER naltrexone prior to discharge between June 29, 2020, and November 30, 2020, were included in the study. The primary outcome measure was alcohol-related readmission 90 days after ER naltrexone administration. Secondary outcomes were the number of emergency department visits, length of hospital stay, and time between hospital admissions. Patients served as their own controls before and after ER naltrexone administration, and data were collected from the electronic medical records. Comparative analysis was performed using descriptive statistics and paired Student t test.Results: 58 patients received ER naltrexone during the study period, with a mean (SD) pre and post 90-day admission rate of 0.60 (1.14) and 0.71 (1.27), respectively, P = .56. Number of emergency department visits before and after the intervention were 0.5 (1.06) and 0.48 (1.40), respectively, P = .93. Length of hospital stay decreased after naltrexone administration (2.92 [1.95] vs 1.18 [1.78] days, P < .005).Conclusion: There was no major difference in the number of hospitalizations or emergency department visits, but there was a decreased length of hospital stay in patients who received ER naltrexone prior to hospital discharge for the treatment of AUD.