A National Survey of Alcohol Care Teams (ACTs) in England: Characteristics of Patients and Components of Care

Background
Recent estimates suggest one in five hospital inpatients drink at harmful levels and one in ten may be alcohol dependent. Alcohol-related admissions continue to increase in England and are estimated to cost the NHS £3.5bn per year. Alcohol Care Teams (ACTs) were set up to address this issue, by training non-specialist staff, developing system-level protocols and delivering patient-level interventions. Existing evidence of effectiveness is limited. This study was the first in a programme of research evaluating ACTs and sought to identify 1) the number, 2) the patient characteristics and 3) the components of care offered by ACTs in England.
Methods
All acute hospitals in England were approached to complete a survey of alcohol care provision. Surveys were completed online, with an appropriate staff member guided by a researcher. Questions were framed in terms of an ‘average month’ in the past year.
Results
144 hospitals participated in the survey; 85 reported having an ACT, 15 an in-reach service, 23 a minimal service and one ‘other’ model. Twenty hospitals reported no provision of alcohol care, another 31 hospitals reporting no alcohol care did not complete the survey.
Preliminary results indicate ACTs received significantly more referrals in a typical month (mean 140.4, 95% CI 120.6-160.3) than in-reach (mean 50.9, 95%CI 27.5-74.2) or minimal service models (mean 81.6, 95%CI 30.3-132.9).
The type of patient seen across the three service types was largely similar, with the majority being male (ACT: mean 62.6%, 95%CI 59.7-65.6; in-reach: mean 62.6%, 95%CI 53.2-72.0; minimal: mean 56.1, 95%CI 46.0-66.3), and white (ACT: mean 77.5%, 95%CI 72.8-82.1; in-reach: mean 70.8%, 95%CI 56.8-84.8; minimal: mean 68.9%, 95%CI 55.7-82.1).
The majority of ACTs (95%), in-reach (93%) and minimal services (78%) reported wards used identification and brief advice (IBA), with 93%, 80% and 86% (respectively) of service models supporting the training and implementation of IBA across the hospital. Most services reported seeing patients requiring medically assisted alcohol withdrawals, with ACTs seeing a significantly higher number in an average month (mean 70.0, 95%CI 56.5-83.6) than in-reach (mean 27.7, 95%CI 12.5-42.8) or minimal services (mean 29.5, 95%CI 20.8-38.3). 21% (n=18) of ACTs, no in-reach services and 9% (n=2) of minimal services offered an ambulatory alcohol withdrawal service.
Conclusion 
Preliminary results indicate that ACTs receive more referrals and see more patients requiring medically assisted alcohol withdrawals in a typical month than other models of care, although the patient populations appear largely similar.
Further analysis will explore the heterogeneity of service offerings between ACTs. Preliminary findings will be shared with public and professional stakeholder groups to discuss the implications and the direction of further analysis. The complete findings  together with coproduced recommendations from the stakeholder group will be presented.