Background: Alcohol-related hospital admissions have doubled in the last ten years to > 1.2 m per year in England. High-need, high-cost (HNHC) alcohol-related frequent attenders (ARFA) are a relatively small subgroup of patients, having multiple admissions or attendances from alcohol during a short time period. This trial aims to test the effectiveness of an assertive outreach treatment (AOT) approach in improving clinical outcomes for ARFA, and reducing resource use in the acute setting. Methods: One hundred and sixty ARFA patients will be recruited and following baseline assessment, randomly assigned to AOT plus care as usual (CAU) or CAU alone in equal numbers. Baseline assessment includes alcohol consumption and related problems, physical and mental health comorbidity and health and social care service use in the previous 6 months using standard validated tools, plus a measure of resource use. Follow-up assessments at 6 and 12 months after randomization includes the same tools as baseline plus standard measure of patient satisfaction. Outcomes for CAU + AOT and CAU at 6 and 12 months will be compared, controlling for pre-specified baseline measures. Primary outcome will be percentage of days abstinent at 12 months. Secondary outcomes include emergency department (ED) attendance, number and length of hospital admissions, alcohol consumption, alcohol-related problems, other health service use, mental and physical comorbidity 6 and 12 months post intervention. Health economic analysis will estimate the economic impact of AOT from health, social care and societal perspectives and explore cost-effectiveness in terms of quality adjusted life years and alcohol consumption at 12-month follow-up.

Aims This study compared prevalence and hospital use among individuals frequently admitted to hospital in England with wholly attributable alcohol-related diagnoses (WAAD), known as alcohol-related frequent attenders (ARFAs), with those of non-alcohol frequent attenders (NAFAs), non-frequent alcohol attenders (ARNFAs) and non-alcohol nonfrequent attenders (NANFAs). Design Cross-sectional and longitudinal analyses of 5 years of England's Hospital Episode Statistics (HES). Setting Hospital inpatients in England, UK, 2011-16. Participants Two cohorts (2011/12 = 489 580/7 654 944 patients and 2015/16 = 490 384/7 660 108 patients) were selected from all adult patients aged ≥ 18 years, treated in English hospitals between 1 April 2011 and 31 March 2016. Patients were categorized as having alcohol-related admissions if diagnoses included a WAAD (ICD-10 classification, WHO, 2016) and frequent admissions if they had more than three hospital admissions during a single HES year. Measurements Prevalence of ARFA, number of admissions (spells), occupied bed-days (OBDs), average length of stay (ALOS) and total admission costs over 5 years were compared among ARFAs, ARNFAs, NAFAs and NANFAs. Findings On average, 0.7% of people admitted to hospital per annum in England 2011-15 were ARFAs and more than a quarter of all frequent attenders (for all causes) to hospitals had a wholly attributable alcohol diagnosis on admission. ARFAs had longer ALOS than the other patient

Background Excess alcohol consumption is a growing public health problem, causing 5•3% of deaths worldwide in those aged under 60 years. In the UK, alcohol use costs the National Health Service (NHS) £3•5 billion annually, 80% of which is used for hospital-based care. Alcohol-related hospital admissions have doubled in the past 8 years in England. With no universal way of identifying hospital admissions of alcohol-related frequent attenders (ARFAs), the true burden on the NHS is unknown including use of accident and emergency services, costs of inpatient admissions, and long-term health and social care. We aimed to identify characteristics of ARFAs to investigate whether they diff er from other hospital service users and to better understand the complexity of this group. MethodsUsing pseudonymised Hospital Episode Statistics data from the Secondary Uses Service, ARFAs (more than three admissions per year, including at least one wholly attributable alcohol diagnosis in any diagnostic fi eld) were identifi ed from all admissions to south London hospitals between April 1, 2013, and March 31, 2014. Comorbidities, age, sex, and income deprivation for ARFAs were compared with those of all other admitted patients. Findings 1897 ARFAs were identifi ed from a total of 366 616 people admitted (5198 [0•7%] of 740 818 admissions). ARFAs were more likely than other admitted patients to be male (72•4% [1373/1897] vs 37•9% [124 919/329 218], p<0•0001), to be income deprived (Index of Multiple Deprivation 04 score 28•04, p<0•0001), and to have comorbidities (22% [417/1897] vs 8% [28 737/364 719]). ARFAs were also more likely to be older than other attenders (mean age ARFAs 55•4 years [SD 15•1] vs alcohol-related non-frequent attenders 50•0 [16•2], p<0•0001, and non-alcohol-related non-frequent attenders 51•6 [20•3], p<0•0001) but younger than non-alcohol-related frequent attenders (55•4 [15•1] vs 56•9 [21•1], p=0•01). Relative risk of comorbidity for ARFAs versus all other patients was 9•35 for self-harm (p<0•0001), 3•29 for assault (p<0•0001), 2•04 for diabetes mellitus (p<0•0001), 1•73 for circulatory disease (p<0•0001), 1•58 for cancer attributable to alcohol (p=0•0292), and 1•45 for mental health (p<0•0001).Interpretation ARFAs have distinct characteristics that diff erentiate them from other patient groups: preliminary analysis shows that ARFAs tend to be older, male, experiencing income deprivation, and more likely to have comorbidities. An understanding of the characteristics of ARFAs and their health service use might help target preventive interventions to this group, reducing harms before high costs for the NHS are accrued.