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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
- Source :
- BMC Public Health, Vol 20, Iss 1, Pp 1-10 (2020), BMC Public Health
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- BackgroundAlcohol-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.MethodsOne 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.DiscussionAOT models piloted with alcohol dependent patients have demonstrated significant reductions in alcohol consumption and use of unplanned National Health Service (NHS) care, with increased engagement with alcohol treatment services, compared with patients receiving CAU. While AOT interventions are costlier per case than current standard care in the UK, the rationale for targeting HNHC ARFAs is because of their disproportionate contribution to overall alcohol burden on the NHS. No previous studies have evaluated the clinical and cost-effectiveness of AOT for HNHC ARFAs: this randomized controlled trial (RCT) targeting ARFAs across five South London NHS Trusts is the first.Trial registrationInternational standard randomized controlled trial number (ISRCTN) registry:ISRCTN67000214, retrospectively registered 26/11/2016.
- Subjects :
- Adult
Male
medicine.medical_specialty
Alcohol Drinking
High need high cost
Cost-Benefit Analysis
Psychological intervention
State Medicine
law.invention
Study Protocol
03 medical and health sciences
0302 clinical medicine
Patient satisfaction
Clinical Protocols
Randomized controlled trial
Assertive outreach treatment
law
London
medicine
Humans
030212 general & internal medicine
Dependence
Frequent attenders
business.industry
lcsh:Public aspects of medicine
Public health
Public Health, Environmental and Occupational Health
Multimorbidity
lcsh:RA1-1270
Emergency department
medicine.disease
Mental health
Comorbidity
3. Good health
Quality-adjusted life year
Hospitalization
Treatment Outcome
Emergency medicine
Female
Emergency Service, Hospital
Alcohol
business
Alcohol-Related Disorders
Facilities and Services Utilization
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 14712458
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- BMC Public Health
- Accession number :
- edsair.doi.dedup.....432d41792fc7816884c49a757c233c30