Interventions to Improve Outpatient Follow-up for Hospitalized Patients With Alcohol Use Disorder : A Systematic Review.

Abstract

Hospitalizations for alcohol use disorder (AUD) are common and morbid. Outpatient follow-up after discharge is critical for reducing alcohol use and subsequent readmissions, but effective interventions to support this transition are unknown. To summarize evidence on the effectiveness of hospital-based interventions to improve outpatient follow-up for AUD. Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo, and CINAHL (January 2000 to February 2025). Two authors independently reviewed abstracts and full-text articles to identify hospital-based trials and cohort studies that evaluated interventions to improve outpatient AUD follow-up versus usual care or an active comparator. Study data were extracted by 2 authors using a standardized template. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool, Newcastle-Ottawa Scale, and GRADE (Grading of Recommendations Assessment, Development and Evaluation). Seventeen studies of 21 interventions (12 randomized clinical trials [RCTs] [<i>n</i> = 1917], 3 nonrandomized trials [<i>n</i> = 459], and 2 cohort studies [<i>n</i> = 9974]) were included. Interventions were heterogeneous, and most (85%) included several components: behavioral (76%), care coordination (76%), medication management (14%), and social support (33%). Eight interventions (38%) reported improved linkage to outpatient follow-up. Effective interventions generally combined behavioral and care coordination with AUD medications or social support. Effect sizes across RCTs ranged from an 8% absolute decrease to a 30% absolute increase in outpatient follow-up. The certainty of evidence was low due to the high risk of bias and imprecision of results. Only English-language publications were included. Few intervention studies of low certainty improved posthospitalization follow-up for patients with AUD. Given the substantial morbidity associated with untreated AUD, high-quality RCTs testing various components of interventions are needed. None. (PROSPERO: CRD42025636943).