Assertive Community Treatment for Alcohol Misuse Disorder Patients Who Are High Utilizers of Emergency Department Services

NCT04447079 | Not Yet Recruiting

• 1 other identifier: ARFA
• Study Type: observational
• Target: 300
• Locations: 0 countries
• Sites: N/A

Brief Summary

Background Frequent attenders (FAs) at emergency department (ED) in Singapore hospitals have been increasing over the years. More than half of the FAs are reported to be alcohol-related frequent attenders (ARFA) and they were found to be using EDs unnecessarily. We aim to assess if there will be a difference in patient outcomes in terms of ED usage and cost-effectiveness by implementing an assertive community treatment (ACT) program to manage AFRAs. Methods This is a prospective, multi-centre, before-and-after, superiority and cohort study to assess the impact of ACT from 4 study sites. 200-300 patients will be recruited and followed up for 12 months. The primary objective of the study is to investigate whether there will be a reduction in AFRA ED attendances. The secondary objective is to estimate the change in total cost utilization. Conclusion/Significance All patients who are on ACT programme will be enrolled in this study. The study intervention will be used as a new mode of care at participating hospitals. We expect to see reduced alcohol addiction level, reduced isolation level, improved motivation and better overall health. With reduced alcohol-related hospital visits, we would also expect to see improved healthcare utilization by ARFAs which will lead to increased cost savings to the healthcare systems and decreased social costs.

Conditions

Alcoholism and Alcohol Abuse; Alcohol Use Disorder; Emergencies

Outcome Measures

Primary Outcomes (1)

• Emergency Department (ED) attendance

  The primary outcome will be the rate of ED visits when comparing the pre-intervention period (12 months) with the post-intervention period (12 months). We anticipate a 25% reduction because of the ACT intervention.

  2 years

Secondary Outcomes (8)

• Emergency Medical Services (EMS) 995 calls

  2 years (12 months pre-intervention, 12 months post-intervention)

• Sustained reduction in ED attendance and EMS calls

  3 years (12 months pre-intervention, 24 months post-intervention)

• Level of Alcohol Dependence by Christo Inventory of Substance-misuse services (CISS score)

  6 months (Baseline and 6 months post-intervention)

• UCLA 3-point Loneliness Scale

  6 months (Baseline and 6 months post-intervention)

• Overall cost savings per patient

  2 years (12 months pre-intervention, 12 months post-intervention)

Study Arms (1)

'Before' and 'After' Arm

Before Arm - This refers to the rate of Emergency Department visits in the pre-intervention period (12 months). After Arm - This refers to the rate of Emergency Department visits in the post-intervention period (12 months) following the START of intervention.

Behavioral: Assertive Community Treatment (ACT)

Interventions

Assertive Community Treatment (ACT) BEHAVIORAL

Assertive Community Treatment (ACT) is part of a 6-month program ARFAs will undergo. ACT teams will engage with ARFAs on a dedicated schedule. Each visit would last an average of 60 minutes. There will not be a re-arrangement of no-show visits. ACT teams will re-engage the ARFA over the phone to plan for the next visit as per the schedule. In keeping with principles of ACT, ARFA's will be assertively sought out in the community and provided intensive engagement, with holistic and supportive care alongside a harm reduction approach. Care will also involve case management and involvement of SSA's. Each interaction during the treatment period will focus on various aspects covering physical health, mental health, and addiction

'Before' and 'After' Arm

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Singapore has a population of 5.7 million, served by 7 adult EDs. Based on unpublished data, we estimate a population of 200-300 patients who would meet the criteria to be classified as ARFA in Singapore. Our study will implement the community-based intervention in ARFAs from 4 adult EDs. Once patients are recruited, individual, identifiable 5-year historical data from the point of study enrolment will be obtained from the electronic medical records system. This data will include dates of ED visits and ED diagnosis. Each intervention site will recruit up to 32 patients per year. The ACT teams will see a maximum of 16 patients over a period of 6 months (Appendix 1). Four hospitals will participate in the study over a period of 4 years with different initiation dates at each site. The setting up of such a service requires on-site specialist guidance and the specialist addictions team from NAMS is only able to guide one hospital's ACT team at a time for a period of 12 months.

You may qualify if:

• Patients who are not on active follow-up at the National Addictions Management Service at the Institute of Mental Health (IMH).
• Patients who speak English or Mandarin.
• Patients who are 21 years of age or older.
• ≧2 SNOMED alcohol-related ED visits in last 12 months AND ≧5 Emergency Department visits (All-cause)
• Patients who are cognitively intact and able to understand and appreciate the contents of the consent.

You may not qualify if:

• Patients who are on active follow-up at the NAMS at the Institute of Mental Health (IMH).
• Patients who are uncontactable by phone AND through opportunistic recruitment.
• Patients who do not give consent.
• Patients who do not speak English or Mandarin.
• Patients who are under 21 years of age.

Sponsors & Collaborators

• Khoo Teck Puat Hospital: lead

Related Publications (4)

• Hughes NR, Houghton N, Nadeem H, Bell J, McDonald S, Glynn N, Scarfe C, Mackay B, Rogers A, Walters M, Smith M, McDonald A, Dalton D. Salford alcohol assertive outreach team: a new model for reducing alcohol-related admissions. Frontline Gastroenterol. 2013 Apr;4(2):130-134. doi: 10.1136/flgastro-2012-100260. Epub 2013 Jan 23.

  PMID: 23502815 RESULT

• Christo G, Spurrell S, Alcorn R. Validation of the Christo Inventory for Substance-misuse Services (CISS): a simple outcome evaluation tool. Drug Alcohol Depend. 2000 May 1;59(2):189-97. doi: 10.1016/s0376-8716(99)00117-9.

  PMID: 10891633 RESULT

• Boh C, Li H, Finkelstein E, Haaland B, Xin X, Yap S, Pasupathi Y, Ong ME. Factors Contributing to Inappropriate Visits of Frequent Attenders and Their Economic Effects at an Emergency Department in Singapore. Acad Emerg Med. 2015 Sep;22(9):1025-33. doi: 10.1111/acem.12738. Epub 2015 Aug 18.

  PMID: 26284824 RESULT

• Wu J, Siddiqui FJ, Mak CCM, Chua ISY, Thangayah JR, Tan EXX, Seet HY, Rao AK, Tan HY, Mohamed A, Hartman M, Leong BS, Ong MEH, Mao DR. Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol. BMC Health Serv Res. 2024 Feb 28;24(1):256. doi: 10.1186/s12913-023-10516-5.

  PMID: 38419049 DERIVED

MeSH Terms

Conditions

Alcoholism; Emergencies

Interventions

Community Mental Health Services

Condition Hierarchy (Ancestors)

Alcohol-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Mental Health Services; Behavioral Disciplines and Activities; Community Health Services; Health Services; Health Care Facilities Workforce and Services

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Target Duration: 2 Years
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 22, 2020
• First Posted: June 25, 2020
• Study Start: August 1, 2020
• Primary Completion: August 1, 2026
• Study Completion (Estimated): August 1, 2027
• Last Updated: August 5, 2020

Record last verified: 2020-07

Data Sharing

• IPD Sharing: Will not share