Assertive outreach treatment versus care as usual for the treatment of high-need, high-cost alcohol related frequent attenders: study protocol for a randomised controlled trial

Abstract

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.

Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol

“…Globally, in 2016, alcohol consumption ranked as the seventh primary cause for both mortality and Disability-Adjusted Life Years (DALYs), attributing to 2.2% of deaths in women and 6.8% in men. Almost one-tenth of worldwide deaths among the age group 15–49 years can be ascribed to alcohol consumption [ 1 ].…”

Understanding the effects of comorbidity severity among high-need, high-cost alcohol-related frequent attenders: A cross-sectional study

“…Risky drinkers tended to utilize expensive services, such as hospitals and emergency departments (ED), rather than primary health care services, which contributed to the high cost of alcohol [2]. HNHC ARFAs are a subset of all patients with alcohol-related hospitalizations and have a relatively high frequency of alcohol-related hospitalizations or attendances over a limited period [3]. Therefore, it is necessary to comprehend the service users and clinical characteristics of the HNHC ARFAs patient group and investigate the potential mechanisms underlying the service use pattern so that policymakers can reduce the price of alcohol.…”

Why Are Some Male Alcohol Misuse Disorder Patients High Utilisers of Emergency Health Services? An Asian Qualitative Study

“…Patients who frequently attend the emergency department (ED) for alcohol-related problems are known as alcohol-related frequent attenders [ 1 ] (ARFAs). While these patients account for a small percentage of the patient population treated by the ED, they utilise a disproportionately large amount of emergency medical resources, which encompass emergency medical services (EMS), ED, and inpatient services [ 2 , 3 ].…”