Treating alcohol abuse cuts hepatitis readmission rates

Counselling for alcohol dependence and abuse can help reduce the 30-day readmission rates for alcoholic hepatitis (AH), according to a study presented at the recently concluded 2022 Digestive Disease Week (DDW 2022).

Despite its benefits, treating alcohol abuse is an underutilized approach of managing not only AH but other alcohol-related disorders as well, the researchers said.

“This should ideally be implemented for all patients hospitalized with not only AH but also all disorders related to alcohol dependence disorder, as it can dramatically impact disease burden and outcomes, such as readmission,” they said.

The present retrospective analysis drew from national readmissions databases and identified 1,552 AH patients who had received counselling for alcohol abuse. A parallel group of 44,065 AH patients who had not undergone counselling was also included as a comparator. Only those who had a principal diagnosis of AH, or of alcohol abuse but with secondary diagnosis of AH, were eligible.  

The rate of hospital readmission for AH was significantly higher in patients who did not vs did receive counselling for their alcohol abuse (11.67 percent vs 7.83 percent; p=0.008). Multivariate Cox regression analysis confirmed the significant beneficial effect of counselling and showed that it could reduce the risk of readmission by nearly 40 percent (hazard ratio, 0.64, 95 percent confidence interval, 0.46–0.91; p=0.01). [DDW 2022, abstract Sa1420]

In addition, patients who underwent therapy for alcohol abuse were more likely to receive a regular discharge (86.7 percent vs 77.42 percent) with lower need for skilled nursing facilities (3.19 percent vs 9.2 percent) or home health care (2.64 percent vs 5.75 percent).

Hospital-related factors seemed to affect the likelihood of receiving interventions for alcohol abuse, with counselling being provided to a larger percentage of patients in large metropolitan centres, as well as private-investor-owned hospitals.

Meanwhile, such a difference in readmission rates could not be attributed to baseline parameters, since age (p=0.42) and sex (p=0.24) distribution did not significantly differ between groups. Median income (p=0.78), insurance status (p=0.61), and bed-size of the hospital they sought care from (p=0.87) were also similar between groups.

According to the researchers, the present findings underscore the value of holistic treatments for alcohol abuse and suggest that hospitals should invest more in these interventions.

"It takes a multidisciplinary approach, starting from the physician or the healthcare provider along with the pharmacists, the behavioural health specialists, or a psychiatrist or psychologist, along with case management as well," explained Dr Harleen Chela, third-year resident at the University of Missouri and Columbia and one of the study authors.

Unfortunately, despite being effective, for many, counselling is too resource-demanding to integrate into routine practice. "It's not always feasible to implement this on the inpatient side, because it takes more than a day or two just to get some of these things put in place,” Chela said.

Future efforts and investments are needed to better establish counselling as a clinical staple.