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

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.

Hospital-based preventative interventions for people experiencing homelessness in high-income countries: A systematic review

“…Studies were published in the US ( n= 13), 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 UK ( n= 8), 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 Australia ( n= 4), 70 , 71 , 72 , 73 and Canada ( n= 3) 74 , 75 , 76 and were similarly distributed across inpatient ( n= 12) 59 , 60 , 62 , 64 , 65 , 66 , 67 , 68 , 69 , 73 , 74 , 76 and emergency settings ( n= 15), 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 61 , 63 , 70 , 71 , 72 , 75 with one study conducted in both inpatient and ED settings. 54 Half were conducted in exclusively homeless populations ( n= 14), 50 , 51 , 54 , 55 , 60 , 62 , 64 , 65 ,…”

“… 54 Half were conducted in exclusively homeless populations ( n= 14), 50 , 51 , 54 , 55 , 60 , 62 , 64 , 65 , 66 , 67 , 68 , 69 , 73 , 76 while the others had a mix of homeless and other patient groups ( n= 14). 52 , 53 , 56 , 57 , 58 , 59 , 61 , 63 , 70 , 71 , 72 , 74 , 75 Over half of studies were classified as methodologically weak ( n= 16). 51 , 53 , 54 , 58 , 62 , 63 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 There were five randomised controlled trials, 56 , 60 , 61 , 65 , 76 two of which were classified as high quality.…”

“… 52 , 53 , 56 , 57 , 58 , 59 , 61 , 63 , 70 , 71 , 72 , 74 , 75 Over half of studies were classified as methodologically weak ( n= 16). 51 , 53 , 54 , 58 , 62 , 63 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 There were five randomised controlled trials, 56 , 60 , 61 , 65 , 76 two of which were classified as high quality. 60 , 65 Counts and proportions of key study characteristics are presented in Table 1 .…”

“…Full study details are provided in Appendix 3. Characteristics n (%) References Country UK 8 (28.6) 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 USA 13 (46.4) 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 Australia 4 (14.3) 70 , 71 , 72 , 73 Canada 3 (10.7) 74 , 75 , 76 Study Design RCT 5 (17.9) 56 , 60 , 61 , 65 , 76 Non-Randomised Trial 1 (3.6) 55 Cohort (including one group and two group before/after studies) 15 (53.6) 50 , 52 , 57 , 58 , 59 , 64 , 67 ...…”

“…We identified eight preventative intervention categories: care coordination ( n= 18 studies); 51 , 52 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 66 , 67 , 69 , 71 , 72 , 73 , 75 advocacy, support, and outreach ( n= 13); 55 , 57 , 58 , 59 , 61 , 64 , 65 , 66 , 67 , 69 , 71 , 73 , 76 social welfare assistance ( n= 13); 52 , 55 , 57 , 58 , 59 , 60 , 61 , 62 , 66 , 67 , 69 , 71 , 76 discharge planning ( n= 12); 55 , 59 , 60 , 62 , 64 , 65 , 66 , 67 , 68 , 69 , 73 , 76 homelessness identification ( n= 6); 50 , 51 , 71 , 73 , 75 psychological therapy and treatment ( n= ...…”