Improving access to treatment for alcohol dependence in primary care: investigating factors that facilitate and impede treatment access and completion

Background: Alcohol-related harm costs the NHS £3.5 billion a year. During the Covid-19 restrictions in 2020, there were 258,811 alcohol-specific hospital admissions; 6983 deaths were related to alcohol-specific causes, an increase of 20% from the previous year; alcohol liver disease deaths increased by 58% compared to baseline. Increasing the number of people in treatment would reduce hospital admissions, yet only 74,618 of the 586,797 estimated alcohol dependent are in treatment. Liverpool has the 3rd highest prevalence (2.53 cases/100,000) of Alcohol Dependence (AD) in England and is also ranked as the 3rd most deprived local authority out of 317 across England. Those in deprived areas drink less, yet suffer higher alcohol related harms (the 'alcohol harm paradox') with higher alcohol-related mortality, and less support for patients once diagnosed. Moreover, 80% of patients who are diagnosed with AD in primary care do not receive pharmacotherapy or psychosocial support within the first year, and patients in deprived areas are less likely to receive pharmacotherapy.

Method: A mixed methods study comprising of: 1.An audit of alcohol dependence presentations in primary care in Liverpool from 2017-2021. 2.Qualitative interviews with patients and health care professionals to understand perceived barriers and facilitators to treatment access.

Results: Incidence and prevalence of AD has increased over the 5-year audit period. AD is more prevalent in more deprived areas and is associated with personal characteristics (occupation, sex, mental health co-morbidities). Qualitative analysis revealed that stigma and accessibility are perceived barriers to accessing treatment whereas positive relationship with practitioner was seen as a facilitator.

Conclusion: The results of this research have been used to develop recommendations for AD treatment pathways in Liverpool CCG, which have implications for other areas of high social deprivation. This work was supported by a project grant from NHS Liverpool CCG.