Assertive outreach for high-need, high-cost alcohol related frequent NHS hospital attenders: characteristics of participants in an RCT of assertive outreach treatment

Background

Alcohol costs the NHS £3.5bn per annum, of which most is in inpatient and emergency care costs. A smaller group of high-need, high-cost (HNHC) alcohol related frequent hospital attenders account for most of these admissions and costs. Alcohol treatment models are insufficient in providing effective care for this group who suffer from severe alcohol dependence, high levels of multimorbidity and higher mortality rates than most other patient groups. Assertive outreach treatment (AOT) aims to maintain regular contact with HNHC alcohol related frequent hospital attenders in the community and is a new treatment model for alcohol dependence in the UK. We have conducted the first RCT of AOT to assess the effectiveness and cost effectiveness. The presentation describes baseline characteristic of HNHC alcohol related frequent hospital attenders, hospital use and cost savings in a treatment population with unmet health and social care needs.

Methods

A randomised, 2-arm, clinical trial to evaluate the effectiveness and cost effectiveness of AOT + care as usual (CAU) versus CAU alone in alcohol related frequent hospital attenders.

Results

In the course of the trial, a total of 174 participants were recruited, half of whom were randomised to AOT + CAU and half to CAU alone. Recruitment took place from four NHS trusts serving the London boroughs of Lambeth and Southwark.

The total sample had a mean age of 52.7 years (SD = 10.6). A majority were male (59.8%) and most were unemployed (85.6%). One in five (19%) had been living with a spouse or partner for the last three months.

Amongst the participants, 27.6% scored between 0 and 15 in the Severity of Alcohol Dependence Questionnaire indicating mild dependence, whereas 23.6% scored between 16 and 30 indicating moderate dependence. A majority of 48.9% scored higher than 30 indicating severe alcohol dependence, which would explain the high levels of multimorbidity and frequent alcohol related hospital admissions. Out of those with severe alcohol dependence, most were male (63.5%). In the sample, 70.7% had been physically sick after drinking in the last six months and 66.1% had felt pain in the stomach after a drinking session. About half (46%) had been in an accident which required treatment after drinking alcohol.

Drinking data for 90 days prior to randomisation, the number of hospital admissions and the length of inpatient admissions as well as data from preliminary cost-effectiveness analysis will be presented.

Conclusions

Until recently AOT had not been applied to people with alcohol dependence. This RCT of AOT is one of the first to do so. Most participants were severely dependent on alcohol with multiple hospital admissions and presentations to Emergency Departments. If care for HNHC alcohol related frequent hospital attenders could be provided through effective AOT in the community rather than in NHS hospitals it could save money in the local health economy, deliver better treatment and reduce the pressure on Emergency Departments.