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Irizar P, Vicary E, Glossop Z, Waller G, Lightowlers C, Quigg Z, Roper L, Gilmore I, Coulton S, Newbury-Birch D, Goodwin L. Working with the police service and homeless services in North West England to reduce alcohol harms: A feasibility study of a tailored Blue Light approach. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209259. [PMID: 38103833 DOI: 10.1016/j.josat.2023.209259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Deaths caused by alcohol are increasing in England and 80 % of people with alcohol use disorders (AUDs) are not in treatment. The Blue Light approach (Alcohol Change UK) is an initiative to support people with AUDs who are not in treatment. This study aimed to tailor the Blue Light approach (combined with alcohol identification and alcohol brief interventions [ABI] training) for police officers and homeless service staff in North West England, and to qualitatively evaluate the feasibility and acceptability of the training. METHODS The Blue Light approach was tailored using co-production activities, based on Transdisciplinary Action Research. Full-day and half-day training sessions were delivered to the police (full-day N = 14, half-day N = 54) and homeless service staff (full-day N = 11, half-day N = 32), in local police stations and online (four half-day sessions). Semi-structured interviews (N = 23) were conducted to evaluate implementation and integration, analysing the qualitative data in line with Normalisation Process Theory. RESULTS Four themes were identified, each with two to three sub-themes, reflecting: (i) the importance of training for working practice, (ii) implementation of the interventions, (iii) changes to relationships within and between organizations, and (iv) recommendations for further changes to the training. Differences in findings across the organizations (police versus homeless services) and by training type attended (full-day versus half-day, in-person versus online) are presented. CONCLUSIONS There is evidence to suggest that the training has provided worthwhile knowledge and intervention techniques that can become embedded into working practices. Nevertheless, structural barriers were apparent, primarily within the police service, with clear disparities between recognising the value of the training and what is achievable in practice, given the competing demands.
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Affiliation(s)
- Patricia Irizar
- Department of Sociology, School of Social Sciences, University of Manchester, UK.
| | - Emily Vicary
- Department of Sociology, School of Social Sciences, University of Manchester, UK
| | - Zoe Glossop
- The Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
| | - Gillian Waller
- School of Social Sciences, Humanities and Law, Teesside University, UK
| | - Carly Lightowlers
- Department of Sociology, Social Policy and Criminology, University of Liverpool, UK
| | - Zara Quigg
- Faculty of Health, Public Health Institute, Liverpool John Moores University, UK
| | - Louise Roper
- Department of Clinical Health Psychology, Liverpool University Hospital Trust, UK
| | - Ian Gilmore
- Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Simon Coulton
- Centre for Health Services Studies, University of Kent, UK
| | | | - Laura Goodwin
- The Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, UK
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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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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: 0] [Impact Index Per Article: 0] [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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Blackwood R, Lynskey M, Drummond C. Prevalence and patterns of hospital use for people with frequent alcohol-related hospital admissions, compared to non-alcohol and non-frequent admissions: a cohort study using routine administrative hospital data. Addiction 2021; 116:1700-1708. [PMID: 33245603 DOI: 10.1111/add.15354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/16/2020] [Accepted: 11/22/2020] [Indexed: 01/12/2023]
Abstract
AIMS This study compared prevalence and hospital use among individuals frequently admitted to hospital in England with wholly attributable alcohol-related diagnoses (WAAD), known as alcohol-related frequent attenders (ARFAs), with those of non-alcohol frequent attenders (NAFAs), non-frequent alcohol attenders (ARNFAs) and non-alcohol non-frequent attenders (NANFAs). DESIGN Cross-sectional and longitudinal analyses of 5 years of England's Hospital Episode Statistics (HES). SETTING Hospital inpatients in England, UK, 2011-16. PARTICIPANTS Two cohorts (2011/12 = 489 580/7 654 944 patients and 2015/16 = 490 384/7 660 108 patients) were selected from all adult patients aged ≥ 18 years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorized as having alcohol-related admissions if diagnoses included a WAAD (ICD-10 classification, WHO, 2016) and frequent admissions if they had more than three hospital admissions during a single HES year. MEASUREMENTS Prevalence of ARFA, number of admissions (spells), occupied bed-days (OBDs), average length of stay (ALOS) and total admission costs over 5 years were compared among ARFAs, ARNFAs, NAFAs and NANFAs. FINDINGS On average, 0.7% of people admitted to hospital per annum in England 2011-15 were ARFAs and more than a quarter of all frequent attenders (for all causes) to hospitals had a wholly attributable alcohol diagnosis on admission. ARFAs had longer ALOS than the other patient groups [5.55 days versus ARNFA 4.7, NAFA 3.39 and NANFA 2.57 days, F = 1088.37 (3, 488 570, P < 0.001)] in the 2015/16 index year; but fewer spells than NAFAs [5.38 ARFAs versus 5.98 NAFAs, F = 20 536.25 (3, 490 380) P < 0.001]. The ARFA cohort reduced in size (from 51 934 ARFAs to 20 548) in the course of 5 years. ARFAs had the highest average total cost of admissions per person over 5 years at £38 189. CONCLUSIONS People with repeated admissions for alcohol-related problems in England appear to be a high-cost, high-need, complex group of patients that makes up more than a quarter of the country's alcohol admissions.
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Affiliation(s)
- Rosalind Blackwood
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
| | - Michael Lynskey
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
| | - Colin Drummond
- Psychology and Neuroscience, King's College London, National Addiction Centre, Institute of Psychiatry, London, UK
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Lintzeris N, Deacon RM, Shanahan M, Clarke J, MacFarlane S, Leung S, Schulz M, Jackson A, Khamoudes D, Gordon DEA, Demirkol A. Evaluation of an Assertive Management and Integrated Care Service for Frequent Emergency Department Attenders with Substance Use Disorders: The Impact Project: Evaluating an assertive management service for frequent ED attenders with substance use disorders. Int J Integr Care 2020; 20:4. [PMID: 32346362 PMCID: PMC7181945 DOI: 10.5334/ijic.5343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/31/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Frequent attenders to Emergency Departments (ED) often have contributing substance use disorders (SUD), but there are few evaluations of relevant interventions. We examine one such pilot assertive management service set in Sydney, Australia (IMPACT), aimed at reducing hospital presentations and costs, and improving client outcomes. METHODS IMPACT eligibility criteria included moderate-to-severe SUD and ED attendance on ≥5 occasions in the previous year. A pre-post intervention design examined clients' presentations and outcomes 6 months before and after participation to a comparison group of eligible clients who did not engage. RESULTS Between 2014 and 2015, 34 clients engaged in IMPACT, with 12 in the comparison group. Clients demonstrated significant reductions in preventable (p < 0.05) and non-preventable (p < 0.01) ED presentations and costs, and in hospital admissions and costs (p < 0.01). IMPACT clients also reported a significant reduction in use days for primary substance (p < 0.01). The comparison group had a significant reduction (p < 0.05) in non-preventable visits only. CONCLUSIONS Assertive management services can be effective in preventing hospital presentations and costs for frequent ED attenders with SUDs and improving client outcomes, representing an effective integrated health approach. The IMPACT service has since been refined and integrated into routine care across a number of hospitals in Sydney, Australia.
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Affiliation(s)
- Nicholas Lintzeris
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
- Discipline of Addiction Medicine, Sydney Medical School, The University of Sydney, AU
| | - Rachel M. Deacon
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
- Discipline of Addiction Medicine, Sydney Medical School, The University of Sydney, AU
| | - Marian Shanahan
- Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Medicine, The University of New South Wales, Sydney NSW, AU
| | - James Clarke
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
| | - Stephanie MacFarlane
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
| | - Stefanie Leung
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
- Discipline of Addiction Medicine, Sydney Medical School, The University of Sydney, AU
| | - Michelle Schulz
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
| | - Anthony Jackson
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
| | - Daniel Khamoudes
- Prince of Wales Hospital Emergency Department, South Eastern Sydney Local Health District, Barker Street, Randwick, NSW, AU
| | - David E. A. Gordon
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
| | - Apo Demirkol
- The Langton Centre, Drug and Alcohol Services, South Eastern Sydney Local Health District, Surry Hills NSW, AU
- School of Public Health and Community Medicine, The University of New South Wales, AU
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Blackwood R, Wolstenholme A, Kimergård A, Fincham-Campbell S, Khadjesari Z, Coulton S, Byford S, Deluca P, Jennings S, Currell E, Dunne J, O’Toole J, Winnington J, Finch E, Drummond C. Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial. BMC Public Health 2020; 20:332. [PMID: 32171278 PMCID: PMC7071678 DOI: 10.1186/s12889-020-8437-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting. METHODS One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up. DISCUSSION AOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first. TRIAL REGISTRATION International standard randomized controlled trial number (ISRCTN) registry: ISRCTN67000214, retrospectively registered 26/11/2016.
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Affiliation(s)
- R. Blackwood
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. Wolstenholme
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. Kimergård
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - S. Fincham-Campbell
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Z. Khadjesari
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - S. Coulton
- University of Kent, Kent, Canterbury, UK
| | - S. Byford
- King’s Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, London, UK
| | - P. Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - S. Jennings
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - E. Currell
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - J. Dunne
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - J. O’Toole
- NIHR Collaborations for Leadership in Applied Health Research and Care South London, London, UK
| | - J. Winnington
- South London and the Maudsley NHS Foundation Trust, London, UK
| | - E. Finch
- South London and the Maudsley NHS Foundation Trust, London, UK
| | - C. Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Development of an alcohol withdrawal risk stratification tool based on patients referred to an addiction liaison nursing service in Glasgow. DRUGS AND ALCOHOL TODAY 2019. [DOI: 10.1108/dat-02-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department.
Design/methodology/approach
A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population.
Findings
The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively.
Research limitations/implications
The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score.
Practical implications
The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life.
Originality/value
The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.
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Moriarty KJ. Alcohol care teams: where are we now? Frontline Gastroenterol 2019; 11:293-302. [PMID: 32582422 PMCID: PMC7307041 DOI: 10.1136/flgastro-2019-101241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/26/2019] [Accepted: 07/07/2019] [Indexed: 02/06/2023] Open
Abstract
Alcohol consumption affects the risks of approximately 230 three-digit disease and injury codes in the International Statistical Classification of Diseases and Related Health Problems-10th Revision. The United Nations Sustainable Development Goals comprise 17 challenging goals with 169 targets, which the 193 Member States aim to achieve by 2030. Action to reduce the harmful use of alcohol, especially addressing global health inequalities, will contribute to achieving many of the health-related goals and targets. Alcohol care teams, mainly developed in acute UK hospitals, reduce acute hospital admissions, readmissions and mortality, improve the quality and efficiency of alcohol care, and have 11 key evidence-based, cost-effective and aspirational components. A clinician-led, multidisciplinary team, with integrated alcohol treatment pathways across primary, secondary and community care, coordinated alcohol policies for emergency departments and acute medical units, a 7-day alcohol specialist nurse service, addiction and liaison psychiatry services, an alcohol assertive outreach team, and consultant hepatologists and gastroenterologists with liver disease expertise facilitate collaborative, multidisciplinary, person-centred care. Quality metrics, national indicators, audit, workforce planning, training and accreditation support research and education of the public and healthcare professionals. Hospitals should collaborate with local authorities, public health, clinical commissioning groups, patients and key stakeholders to develop and disseminate cost-effective prevention and treatment strategies. Globally, alcohol care teams can support the achievement of the United Nations Sustainable Development Goals, and should be advocated and implemented through the WHO global alcohol strategy. This requires collaborative care planning by key stakeholders, a skilled workforce, targeted financial resources and dedicated political commitment.
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A National Survey of Assertive Outreach Treatment Services for People Who Frequently Attend Hospital due to Alcohol-Related Reasons in England. Alcohol Alcohol 2017; 53:277-281. [DOI: 10.1093/alcalc/agx095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
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Burton R, Sheron N. Missed opportunities for intervention in alcohol-related liver disease in the UK. Lancet Gastroenterol Hepatol 2017; 2:469-471. [DOI: 10.1016/s2468-1253(17)30082-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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Currie C, Davies A, Ariti C, Bardsley M. The impact of alcohol care teams on emergency secondary care use following a diagnosis of alcoholic liver disease - a national cohort study. BMC Public Health 2016; 16:685. [PMID: 27484915 PMCID: PMC4970255 DOI: 10.1186/s12889-016-3350-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/22/2016] [Indexed: 12/04/2022] Open
Abstract
Background The increasing mortality rates from alcohol-related liver disease (ARLD) are a public health concern. To address this, alcohol care teams (ACT) case-find and lead management of alcohol issues for these patients. Local assessments of ACTs have shown reductions in emergency admissions and emergency department attendances. We examine the impact of ACTs on emergency hospital activity following a diagnosis of ARLD. Methods Administrative Hospital Episode Statistics (HES) data were extracted. Information on ACT provision at English NHS hospital trusts and sites in 2009/10 was taken from a survey by Public Health England. We undertook a difference-in-difference analysis to compare emergency hospital activity for a cohort of individuals diagnosed with ARLD who presented to hospitals either with or without an ACT in the one year before and after a first ARLD diagnosis during 2009/10. Results Over the study period, 9,165 individuals eligible for inclusion in our study had a first diagnosis of ARLD. 4,768 presented to one of 41 hospital trusts with an ACT (59 sites) and 4,397 presented to one of 50 non-ACT hospital trusts (65 sites). Whilst age and sex demographics were similar between the two cohorts, the ACT hospital cohort had a higher proportion of individuals in the most deprived quintile (41.6 % v 28.5 % p < .0001). In the difference-in-difference analysis, the presence of an ACT at a hospital trust was not associated with a change in all-cause emergency admissions (0.020 (95 % CI −0.070, 0.111), p = 0.656), alcohol-related emergency admissions (−0.025 (95 % CI −0.104, 0.054), p = 0.536) or all-cause emergency department attendances (0.042 (95 % CI −0.087, 0.171), p = 0.521). Sensitivity analyses by sex and hospital site did not affect the study findings. Conclusions In this study, the presence of an ACT at the NHS hospital trust where individuals have their first recorded diagnosis of ARLD does not appear to be associated with subsequent emergency hospital activity within these populations. Further analysis focussing on the components and specific effects of ACT interventions on individuals and systems both pre- and post-diagnosis of ARLD may reveal important avenues to improve care.
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Affiliation(s)
- Claire Currie
- Nuffield Trust, 59 New Cavendish St, London, W1G 7LP, UK.
| | - Alisha Davies
- Nuffield Trust, 59 New Cavendish St, London, W1G 7LP, UK
| | - Cono Ariti
- London School of Hygiene and Tropical Medicine, Keppel Street, London, W1CE 7HT, UK
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Owens L, Kolamunnage-Dona R, Owens A, Perkins L, Butcher G, Wilson K, Beale S, Mahon J, Williamson P, Gilmore I, Pirmohamed M. A Randomized Controlled Trial of Extended Brief Intervention for Alcohol-Dependent Patients in an Acute Hospital Setting. Alcohol Alcohol 2016; 51:584-92. [DOI: 10.1093/alcalc/agw023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 04/03/2016] [Indexed: 11/14/2022] Open
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Dore G, Sinclair B, Murray R. Treatment Resistant and Resistant to Treatment? Evaluation of 40 Alcohol Dependent Patients Admitted for Involuntary Treatment. Alcohol Alcohol 2015; 51:291-5. [PMID: 26362017 DOI: 10.1093/alcalc/agv103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/20/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe the clinical outcomes for a group of patients with severe alcohol dependence discharged from an Involuntary Drug and Alcohol Treatment (IDAT) program. METHODS Forty patients admitted to an inpatient IDAT program were prospectively followed up over 6 months using standardized questionnaires. RESULTS Patients had high rates of mental health comorbidities (97.5%), cortical atrophy (40%) and socioeconomic disadvantage (92.5% were beneficiaries). Six months after discharge, 25% of patients were abstinent and living in the community and 17.5% had notably reduced alcohol use. A further 7.5% were abstinent due to involuntary hospitalization. A total of 10% of patients were deceased and 40% of patients had relapsed or were lost to follow-up. Number of admissions and admission days reduced by 51 and 45% respectively for the 17 abstinent or improved community-based patients. A total of 82% of this patient group were actively engaged with an Assertive Community Treatment (ACT) team. CONCLUSIONS While patient numbers are small, treatment responsiveness was evident for 42.5% of patients, most of whom were followed up with ACT. Evaluation with a comparator group is required to determine whether outcomes are a function of involuntary treatment or an assertive treatment approach.
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Affiliation(s)
- Glenys Dore
- Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia
| | - Barbara Sinclair
- Drug & Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Robin Murray
- Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia
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Williams R, Aspinall R, Bellis M, Camps-Walsh G, Cramp M, Dhawan A, Ferguson J, Forton D, Foster G, Gilmore I, Hickman M, Hudson M, Kelly D, Langford A, Lombard M, Longworth L, Martin N, Moriarty K, Newsome P, O'Grady J, Pryke R, Rutter H, Ryder S, Sheron N, Smith T. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet 2014; 384:1953-97. [PMID: 25433429 DOI: 10.1016/s0140-6736(14)61838-9] [Citation(s) in RCA: 415] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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