- Design
- Systematic review of 12 RCTs, 3 non-randomised trials and 2 cohorts
- Population
- Hospitalised adults with alcohol use disorder
- Primary outcome
- Linkage to outpatient alcohol use disorder follow-up
- Effect
- 8 of 21 interventions improved linkage; RCT effects −8 to +30 points; low certainty
A systematic review in Annals of Internal Medicine looked for hospital-based interventions that improve outpatient follow-up after an admission for alcohol use disorder. It found 17 studies of 21 interventions: 12 randomised trials (1,917 patients), 3 non-randomised trials and 2 cohort studies.
Only 8 of the 21 interventions improved linkage to outpatient care. Those that did generally combined behavioural support and care coordination with alcohol use disorder medication or social support. Effects in randomised trials ranged from an 8-point fall to a 30-point rise in follow-up. Certainty was low.
The review says less about which single intervention works than about what does not: a discharge letter and advice to seek help rarely achieve follow-up. Patients who leave without a plan, a medication and a named contact are the ones lost.
The evidence is weak, but the components are low-risk and already recommended. Build them into the discharge of every patient admitted with alcohol use disorder.
- Book a specific outpatient appointment for alcohol use disorder before the patient leaves
- Consider starting medication for alcohol use disorder during the admission
- Involve an addiction liaison, social worker or care coordinator where available
- Address social needs, such as housing, that make follow-up unlikely
- Tell the primary care doctor directly, not only in the discharge summary
Why it matters
Advice and a discharge letter alone rarely get these patients to follow-up.
Don't overread it
Certainty was low and interventions varied widely, so no single package has been proven to work.
The statistics, in plain English
The range from −8 to +30 percentage points across trials shows how inconsistent the interventions were; low certainty under GRADE means the true effect could differ substantially from what these studies suggest.
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