3. Alcohol Assertive Outreach Treatment randomised controlled trial: a mixed methods economic evaluation

Nine per cent of people with alcohol dependence account for 59% of all alcohol attributable hospital admissions in England. People who regularly attend hospital for alcohol-related reasons – or 'high-need, high-cost' (HNHC) patients – often have high multimorbidity, complex social support needs and tend not to be engaged with community alcohol services. Alcohol Assertive Outreach Treatment (AAOT) provides extended and intensive support for this population. We aimed to carry out a qualitative evaluation, to explain the findings of a within-trial economic evaluation comparing AAOT with care as usual across two South London boroughs.

Qualitative interviews were carried out with a purposive sample of participants from both arms of a randomised controlled trial comparing AAOT with care as usual. Semi-structured interviews were designed to elicit experiences of health care and support received over a twelve-month period, including perceived facilitators and barriers to engagement with care and positive clinical outcomes. Interviews were transcribed verbatim and analysed thematically with particular focus on factors likely to influence cost-effectiveness. Findings were then integrated with an economic evaluation as part of a mixed methods approach.

Themes emerging of importance to participants were the interpersonal and practical aspects of AAOT. These included therapeutic style, keyworker relationship, keyworker qualities, and format, breadth and flexibility of the support provided.

Findings from this study will improve understanding of the mechanisms driving the costeffectiveness of AAOT, leading to refined clinical care models and informed policy and commissioning decisions, appropriate to serve the HNHC alcohol patient population.