Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits

Abstract

Objectives: Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system. Methods: Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed. Results: For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001). Conclusions: AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.

Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study

“…[32][33][34] Promising strategies include screening, brief intervention, treatment referrals, 35 managed alcohol programs 36 and case management. 37 Rapid access to addiction medicine clinics has been shown to reduce both substance use 38 and emergency department visits, 39 and may also have an impact on mortality in frequent users of emergency departments for alcohol-related mental and behavioural disorders. ‡Decreasing frequency with increasing ED use; not statistically significant.…”

Risk factors associated with 1-week revisit among emergency department patients with alcohol withdrawal

“…Patients directly referred to treatment may be far more likely to enrol in a formal treatment program as those undergoing standard care [30,31]. Other options referral to a rapid outpatient clinic: an Ottawa initiative reduced all-cause ED visits by 80% while decreasing alcohol use, anxiety, and depression [32].…”

Assessment of Age and Sex Differences in Risk of 1-Year Mortality After Emergency Department Visits Caused by Alcohol Use

“… 1 , 2 , 4 Studies suggest that improving uptake of brief alcohol interventions delivered in the ED and increasing access to medical services for addiction may reduce harm associated with use of alcohol. 5 , 6 …”