{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T07:26:01Z","timestamp":1785741961109,"version":"3.56.0"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,1,24]],"date-time":"2018-01-24T00:00:00Z","timestamp":1516752000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Naltrexone trials have demonstrated improved outcomes for patients with alcohol use disorders. Hospital initiation of naltrexone has had limited study.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>To describe the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal about naltrexone.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>A pre\u2010post study analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>SETTING<\/jats:title><jats:p>A tertiary academic center.<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>Patients hospitalized for alcohol withdrawal.<\/jats:p><\/jats:sec><jats:sec><jats:title>INTERVENTIONS<\/jats:title><jats:p>(1) Provider education about the efficacy and contraindications of naltrexone and (2) algorithms for evaluating patients for naltrexone.<\/jats:p><\/jats:sec><jats:sec><jats:title>MEASUREMENTS<\/jats:title><jats:p>The percentages of patients counseled about and prescribed naltrexone before discharge and the percentages of pre\u2010 and postintervention patients with 30\u2010day emergency department (ED) revisits and rehospitalizations.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>We identified 128 patient encounters before and 114 after implementation. The percentage of patients counseled about naltrexone rose from 1.6% preimplementation to 63.2% postimplementation (<jats:italic>P<\/jats:italic> &lt; .001); the percentage of patients prescribed naltrexone rose from 1.6% to 28.1% (<jats:italic>P<\/jats:italic> &lt; .001). Comparing preintervention versus postintervention groups, there were no unadjusted differences in 30\u2010day ED revisits (25.8% vs 19.3%; <jats:italic>P<\/jats:italic> = .23) or rehospitalizations (10.2% vs 11.4%; <jats:italic>P<\/jats:italic> = .75). When adjusted for demographics and comorbidities, postintervention patients had lower odds of 30\u2010day ED revisits (odds ratio [OR] = 0.47; 95% confidence interval [CI], 0.24\u20100.94) but no significant difference in rehospitalizations (OR = 0.76; 95% CI, 0.30\u20101.92). In subgroup analysis, postintervention patients counseled versus those not counseled about naltrexone were less likely to have 30\u2010day ED revisits (9.7% vs 35.7%; <jats:italic>P<\/jats:italic> = .001) and rehospitalizations (2.8% vs 26.2%; <jats:italic>P<\/jats:italic> &lt; .001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The implementation of a process for counseling patients hospitalized for alcohol withdrawal about using naltrexone for the maintenance of sobriety was associated with lower 30\u2010day ED revisits but no statistically significant difference in rehospitalizations.<\/jats:p><\/jats:sec>","DOI":"10.12788\/jhm.2900","type":"journal-article","created":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T12:43:32Z","timestamp":1519130612000},"page":"221-228","source":"Crossref","is-referenced-by-count":68,"title":["Implementation of a Process for Initiating Naltrexone in Patients Hospitalized for Alcohol Detoxification or Withdrawal"],"prefix":"10.1002","volume":"13","author":[{"given":"John R.","family":"Stephens","sequence":"first","affiliation":[{"name":"Department of Medicine Division of Hospital Medicine University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlton","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hospital Medicine University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly V.","family":"Stepanek","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hospital Medicine University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Garbutt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"Starke","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Liles","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of Hospital Medicine University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Jonas","sequence":"additional","affiliation":[{"name":"Department of Medicine Division of General Medicine and Clinical Epidemiology University of North Carolina School of Medicine Chapel Hill North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,1,24]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.64.7.830"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2011.06.045"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.156.11.1758"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000172071.81258.04"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2002.tb02682.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.60.1.92"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2002.tb04550.x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.2001.961115654.x"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1992.01820110045007"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1530-0277.2008.00682.x"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.3628"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ALC.0000095861.43232.19"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(03)00134-0"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2968-9"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2751-3"},{"key":"e_1_2_5_17_1","volume-title":"The 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