Alcohol intoxication management services in the night-time economy are highly acceptable to their users but they may not reduce demand on emergency services: a mixed methods study.

Background

Alcohol-related harms arising in the Night-Time Economy (NTE) impose a substantial burden on ambulance, police and hospital Emergency Departments. Alcohol Intoxication Management Services (AIMS) have been implemented in the NTE areas of some towns and cities in the UK and abroad in an effort to reduce use of emergency services. AIMS provide basic care for intoxication and minor injuries and may be a place of safety for patrons of the NTE who are unable to look after themselves. However, it is not known whether AIMS are an acceptable intervention to those who are treated there.

Methods

As part of a large multicentre evaluation of the effectiveness and cost effectiveness of AIMS this study explored the experiences of attending an AIMS and examined the acceptability to their users. A sequential mixed methods approach including interviews and a survey was undertaken involving a convenience sample of adults (>18) who attended six different AIMS in the UK between June 2016 and October 2017.

Results

Telephone semi-structured interviews were undertaken with 19 AIMS users (12 Male, 7 Female) and 208 surveys were received (53.2% male, 46.8% female, 57.5% aged 17-24 years, 24.5% aged 25-34 years and 17.0% aged 35+ years) The majority of survey respondents (57.2%) indicated their AIMS attendance was intoxication-related. A sizable proportion of interviewees were workers in the night time economy who had suffered an injury.

The majority of survey respondents (67%) rated their overall experience of AIMS as 10/10, with a further 30% rating it 7-9/10. Survey and interview findings were consistent and showed AIMS care was a highly acceptable intervention for their users. All aspects of care received in the AIMS were regarded positively, especially the caring and friendly approach of staff. If the AIMS had not been available a third (31.3%) of survey respondents indicated that they would have been unsafe and a minority (14.9%) said they would have contacted emergency services or gone to the ED (24.4%). This suggests only a minority of AIMS users were potentially diverted from the ED.

Discussion and conclusions AIMS offer a highly acceptable intervention to all their users regardless of intoxication or minor injury. To our knowledge, this is the first study to explore the experiences of AIMS users so provides new evidence for emergency medicine practitioners, researchers and decision makers considering implementing AIMS. For the latter particularly, while only a minority were likely to be diverted from using emergency services, it is important to consider potential unmet social need around the safety of patrons in the NTE. Although AIMS users expressed high levels of satisfaction with their care, these additional AIMS services may be addressing unmet social demand rather than diverting ED demand. This evaluation will provide vital effectiveness and cost-effectiveness evidence to shape any future decisions around the implementation of AIMS.