A Philadelphia-based Penn Medicine intervention increased the likelihood that emergency department patients with alcohol use disorder would receive naltrexone prescriptions by 15-fold, according to a study published in the Annals of Emergency Medicine.
Researchers from the Perelman School of Medicine at the University of Pennsylvania implemented the interventions at four University of Pennsylvania Health System hospitals beginning in March 2024 and compared prescribing rates with two hospitals that served as controls. Phase two began in August 2024. The analysis included two-and-a-half years of baseline data collected before March 2024 and tracked prescribing rates through both intervention periods.
Here are five things to know:
- Naltrexone prescribing was uncommon before the intervention. At baseline, 13 patients, or 0.2% of those with an alcohol-related diagnosis, received a naltrexone prescription from the emergency department.
- Researchers tested two phases of interventions. Phase one established standardized care steps and a discharge order with a prepopulated naltrexone prescription. Phase two added alcohol screening questions during triage and EHR alerts for patients who screened potentially positive for harmful drinking.
- Prescribing rates increased after implementation. Naltrexone prescribing rose to 2.7% of patients with an alcohol-related diagnosis during phase one and 3.2% during phase two.
- Prescribing rates increased after implementation. Researchers found a 12-fold increase in the likelihood of receiving a naltrexone prescription during phase one and a 15-fold increase during phase two.
- Results differed sharply from hospitals that did not use the intervention. At two control hospitals, naltrexone prescribing remained at 0.3% of patients with an alcohol-related diagnosis. Across the intervention hospitals, 99 patients received naltrexone prescriptions in just over a year, and 46 clinicians prescribed the medication.
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