Salford alcohol assertive outreach team: a new model for reducing alcohol-related admissions

Abstract

ObjectiveAlcohol-related admissions are increasing. A significant number of these admissions are attributable to a small number of complex patients with other comorbidities who do not engage well with mainstream services. Assertive outreach teams have been used in the field of psychiatry to engage patients who are poorly compliant. This study examines whether an alcohol assertive outreach team (AAOT) can engage with this group and reduce hospital admissions.DesignThe AAOT is a multidisciplinary team with medical, psychiatric, substance misuse, psychology, nursing and social work specialists. The team worked with patients with the highest number of alcohol-related admissions and case managed in a community setting for 6 months. The admission and emergency department attendances of the cohort were compared for the 3-month period before and after the intervention. Christo inventory for substance misuse services (CISS) scores were determined pre and post the intervention period.Results54 patients were case managed. The total number of admissions in 3 months fell from 151 prior to the intervention period to 50 following the intervention. Emergency department attendances also fell from 360 in 3 months to 146 following the intervention period. CISS scores fell from 11 preintervention to eight postintervention.ConclusionsAn AAOT model appears to reduce hospital admissions and emergency department attendances in a complex group of patients that display high alcohol-related admissions.

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

“…The low participant numbers suggest caution is required in generalising conclusions. Nevertheless, the study has higher or similar numbers than in previous evaluations of similar programs, and the general findings are consistent with previous reports [14][15][16]. While our study had a comparison group, these participants were not randomly allocated.…”

“…Evaluations of assertive care management programs for this client group are more encouraging. An assertive management service in the UK resulted in a 67% reduction in the number of hospital admissions, and a 59% reduction in ED presentations in the three months following the intervention period [14]. Similar reductions in ED presentations were demonstrated in US programs [15,16].…”

Alcohol care teams: where are we now?

“…Hospital admissions were reduced by 67%, and ED attendances by 59%, with savings of £607 000 and patients moved into supported, community environments. The team also works proactively with patients who have had two recent alcohol-related admissions, the so-called ‘fast risers’ 44…”

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

“…AOT is based on a model of community service provision originally designed for people with severe mental illness (SMI) and was first pioneered by the work of Stein and Test (1980) [13]. AOT emphasises active engagement over an extended period [14,15] and has several features which distinguish it from usual care, including: (i) rapid access to services, (ii) a small caseload, (iii) a high ratio of community to office-based appointments, (iv) assertive engagement (e.g. with multiple attempts) and (v) a shared care approach, with care coordinators working within a multidisciplinary team that meets frequently [16,17].…”