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Hemrage S, Parkin S, Kalk N, Shah N, Deluca P, Drummond C. Treatment engagement in comorbid alcohol use disorder and alcohol-related liver disease: A qualitative exploration of barriers and facilitators with service users. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1965-1978. [PMID: 39191646 DOI: 10.1111/acer.15427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/19/2024] [Accepted: 08/01/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Effective interventions to improve patient outcomes in comorbid alcohol use disorder (AUD) and alcohol-related liver disease (ARLD) remain a clinical unmet need. While the choice of abstinence is the cornerstone for the prevention of disease progression and mortality, evidence suggests a suboptimal engagement with treatment supporting recovery. This qualitative investigation aims to understand barriers and facilitators to treatment as experienced by this clinical population by applying a multidimensional adherence model proposed by the World Health Organization. METHODS Twenty-four participants with comorbid AUD and ARLD were recruited from an inpatient clinical setting. Data for this study were collected through semistructured, in-depth interviews. Deductive analysis was organized by the Framework method, and theory-driven themes were identified according to the multidimensional adherence model. This included factors across the social and economic, patient, condition, treatment, and healthcare system levels. RESULTS The findings in this study indicate systematic challenges in maintaining continuity between primary, secondary, and community care. Aspects related to social and economic context, treatment, and healthcare systems were found to hinder engagement. Identified facilitators to engagement included the participatory role of family, shared lived experience of addiction/recovery, and therapeutic alliance with healthcare providers. CONCLUSION The understanding of these barriers and facilitators from a service user's perspective can bridge the treatment gap for this clinical population. This can provide an opportunity for the implementation of effective interventions and inform the development of policies promoting accessible care. Government and public health bodies have fundamental roles in shifting treatment paradigms in comorbid AUD and ARLD.
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Affiliation(s)
- Sofia Hemrage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Parkin
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Public Health, Environments and Society at London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Kalk
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Naina Shah
- Institute of Liver Studies, Cheyne Wing (Third Floor), King's College Hospital, London, UK
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Terasaki D, Hanratty R, Thurstone C. More than MAT: lesser-known benefits of an inpatient addiction consult service. Hosp Pract (1995) 2023; 51:107-109. [PMID: 37314327 DOI: 10.1080/21548331.2023.2225977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/13/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Dale Terasaki
- Department of Behavioral Health Services, Denver Health & Hospital Authority, Denver, CO, USA
| | - Rebecca Hanratty
- Department of Ambulatory Care Services, Denver Health & Hospital Authority, Denver, CO, USA
| | - Christian Thurstone
- Department of Behavioral Health Services, Denver Health & Hospital Authority, Denver, CO, USA
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Goh P, Md Amir Ali LAB, Ou Yong D, Ong G, Quek J, Banu H, Wu JT, Mak CCM, Mao DR. Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10795. [PMID: 36078521 PMCID: PMC9518548 DOI: 10.3390/ijerph191710795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Certain alcohol misuse patients heavily utilise the Emergency Department (ED) and Emergency Medical Services (EMS) and may present with intoxication or long-term sequelae of alcohol misuse. Our study explored reasons for repeated ED/EMS utilisation and sought to understand perpetuating and protective factors for drinking. METHODS Face-to-face semi-structured qualitative interviews were conducted. Participants were recruited from an ED in Singapore. Interviews were audio-recorded, transcribed verbatim and underwent manual thematic analysis. Emergent themes were independently reviewed for agreement. Data from medical records, interview transcripts, and field notes were triangulated for analysis. RESULTS All participants were male (n = 20) with an average age of 55.6 years (SD = 8.86). Most were unemployed (75%), did not have tertiary education (75%), were divorced (55%), and had pre-existing psychiatric conditions (60%) and chronic cardiovascular conditions (75%). Reasons for utilisation included a perceived need due to symptoms, although sometimes it was bystanders who called the ambulance. ED/EMS was preferred due to the perceived higher quality and speed of care. Persistent drinking was attributed to social and environmental factors, and as a coping mechanism for stressors. Rehabilitation programs and meaningful activities reduced drinking tendencies. CONCLUSION ED/EMS provide sought-after services for alcohol misuse patients, resulting in high utilisation. Social and medical intervention could improve drinking behaviours and decrease overall ED/EMS utilisation.
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Affiliation(s)
- Pamela Goh
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | | | - Donovan Ou Yong
- Emergency Department, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Gabriel Ong
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jane Quek
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Halitha Banu
- Home Team Behavioural Sciences Centre, Ministry of Home Affairs, Singapore 698928, Singapore
| | - Jun Tian Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117456, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore 539747, Singapore
| | - Desmond Renhao Mao
- Acute & Emergency Care Department, Khoo Teck Puat Hospital, Singapore 768828, Singapore
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Alderson H, Mayrhofer A, Smart D, Muir C, McGovern R. An Innovative Approach to Delivering a Family-Based Intervention to Address Parental Alcohol Misuse: Qualitative Findings from a Pilot Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8086. [PMID: 35805744 PMCID: PMC9265291 DOI: 10.3390/ijerph19138086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 12/04/2022]
Abstract
Within child welfare systems, the issue of parental alcohol misuse (PAM) and the responsibility for supporting children affected by PAM impacts on multiple health and social care services. An innovation pilot project (IPP) was set up to reduce the fragmentation between services and to help identify children affected by PAM. The current study presents findings regarding the IPP, examining its implementation, the service delivery, and the perceived impact for family members. Qualitative data were collected from 41 participants. This included interviews with alcohol-misusing parents (n = 13), affected adult family members (n = 5), and children affected by PAM (n = 9). Two focus groups and three one-to-one interviews were conducted with project workers (n = 7) and multi-agency service managers (n = 7). Data were analysed thematically relating to three main themes: (1) innovation in team composition and multi-disciplinary team working, (2) innovative ways of working, and (3) the benefits of a whole-family approach. The findings highlighted the importance of time for the team to 'bed in' and come together under one structure, a focus and oversight on whole-family care, and the importance of offering early, targeted, and flexible interventions to prevent crisis points and manage the consequences of PAM. Consideration will need to be given to joint commissioning to strengthen family-focused support.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Baddiley Clarke Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK; (A.M.); (D.S.); (C.M.); (R.M.)
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Mak CCM, Mao DRH, Siddiqui FJ, Lim A, Davamoni-Thomas J, Tang JP, Bachik R, Ng CWL, Kandasami G, Lee C. A new paradigm in management of frequent attenders to emergency departments with severe alcohol use disorder-A pilot study for assertive community treatment in Singapore. FRONTIERS IN HEALTH SERVICES 2022; 2:1029455. [PMID: 36925838 PMCID: PMC10012780 DOI: 10.3389/frhs.2022.1029455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Introduction A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction. Materials and methods We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed. Results All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period (Z = -2.244, p = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, p = 0.001), corresponding to reduction in alcohol-related problem severity. Conclusion This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.
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Affiliation(s)
- Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Fahad Javaid Siddiqui
- Prehospital and Emergency Care Research Center (PERC), Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Alex Lim
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jayson Davamoni-Thomas
- Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore, Singapore
| | - June Peiwen Tang
- Clinical and Forensic Psychology Service, Ministry of Social and Family Development, Singapore, Singapore
| | - Rozinah Bachik
- Education Office, Institute of Mental Health, Singapore, Singapore
| | - Charis Wei Ling Ng
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
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Vanderplasschen W, Rapp RC, De Maeyer J, Van Den Noortgate W. A Meta-Analysis of the Efficacy of Case Management for Substance Use Disorders: A Recovery Perspective. Front Psychiatry 2019; 10:186. [PMID: 31057432 PMCID: PMC6477913 DOI: 10.3389/fpsyt.2019.00186] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 03/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Case management is a client-centered approach to improve the coordination and continuity of service delivery, especially for persons with substance use disorders (SUD) and multiple and complex support needs. This intervention supports individuals by helping them identify needed services, facilitate linkage with services, and promote participation and retention in services. However, it is questionable whether case management is equally effective in promoting recovery and aspects of personal functioning. The objective was to conduct an updated meta-analysis and to assess whether case management was more effective than treatment as usual (TAU) among persons with SUD for improving treatment-related (e.g., successful linkage with and retention in treatment) as well as personal functioning outcomes (e.g., substance use). Methods: This meta-analysis focuses on randomized controlled trials (RCTs) that included persons with alcohol or drug use disorders and compared case management with TAU. To be eligible, interventions had to meet core case management functions as defined in the literature. We conducted searches of the following databases to May 2017: the Cochrane Drugs and Alcohol Specialized Register, CENTRAL, PubMed, Embase, CINAHL, and Web of Science. Also, reference lists of retrieved publications were scanned for relevant (un)published studies. Results: The overall effect size for case management compared to TAU across all outcome categories and moments was small and positive (SMD = 0.18, 95% CI 0.07-0.28), but statistically significant. Effects were considerably larger for treatment tasks (SMD = 0.33, 95% CI 0.18-0.48) than for personal functioning outcomes (SMD = 0.06, 95% CI -0.02 to 0.15). The largest effect sizes were found for retention in substance abuse treatment and linkage with substance abuse services. Moderator effects of case management models and conditions were assessed, but no significant differences were observed. Conclusions: The primary results from earlier meta-analyses were supported: case management is more effective than TAU conditions for improving outcomes, but this effect is significantly larger for treatment-related tasks than for personal functioning outcomes. Case management can be an important supplement to available services for improving linkage and retention, although further research is needed to assess its potential for supporting recovery from a longitudinal perspective.
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Affiliation(s)
| | - Richard C Rapp
- Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Jessica De Maeyer
- Centre of Expertise on Quality of Life, University College Ghent, Ghent, Belgium
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Affiliation(s)
- Colin Drummond
- Professor of Addiction Psychiatry, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London 4 Windsor Walk, London SE5 8BB, United Kingdom
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Morandi S, Silva B, Golay P, Bonsack C. Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:26. [PMID: 28545572 PMCID: PMC5445418 DOI: 10.1186/s13011-017-0111-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/19/2017] [Indexed: 11/13/2022]
Abstract
Background Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention. Methods The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. Results A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. Conclusions These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse.
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Affiliation(s)
- Stéphane Morandi
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Benedetta Silva
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Philippe Golay
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Charles Bonsack
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
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