Background Alcohol intoxication management services (AIMS) provide an alternative care pathway for alcohol-intoxicated adults otherwise requiring emergency department (ED) services and at times of high incidence. We estimate the effectiveness and cost-effectiveness of AIMS on ED attendance rates with ED and ambulance service performance indicators as secondary outcomes.
Methods A controlled longitudinal retrospective observational study in English and Welsh towns, six with AIMS and six without. Control and intervention cities were matched by sociodemographic characteristics. The primary outcome was ED attendance rate per night, secondary analyses explored hospital admission rates and ambulance response times. Interrupted time series analyses compared control and matched intervention sites pre-AIMS and post-AIMS. Cost-effectiveness analyses compared the component costs of AIMS to usual care before with results presented from the National Health Service and social care prospective. The number of diversions away from ED required for a service to be cost neutral was determined.
Results Analyses found considerable variation across sites, only one service was associated with a significant reduction in ED attendances (−4.89, p<0.01). The services offered by AIMS varied. On average AIMS had 7.57 (mean minimum=1.33, SD=1.37 to mean maximum=24.66, SD=12.58) in attendance per session, below the 11.02 diversions away from ED at which services would be expected to be cost neutral.
Conclusions AIMSs have variable effects on the emergency care system, reflecting variable structures and processes, but may be associated with modest reductions in the burden on ED and ambulance services. The more expensive model, supported by the ED, was the only configuration likely to divert patients away from ED. AIMS should be regarded as fledgling services that require further work to realise benefit.
Trial registration number ISRCTN63096364.
- alcohol abuse
- cost effectiveness
- emergency care systems
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Handling editor Richard Body
Contributors SM was project lead, interpreted the data and contributed to the manuscript. TY undertook the data analysis, effectiveness modelling and contributed to the manuscript. AI was project manager, undertook data collection and interpretation. SG led the effectiveness modelling and interpretation and contributed to the manuscript. AB led the cost-effectiveness modelling and contributed to the manuscript. YA undertook additional data analysis and contributed to the manuscript.
Funding This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 14/04/25). Tracey Young was supported in the preparation/submission of this paper by the HEOM Theme of the NIHR CLAHRC Yorkshire and Humber. www.clahrc-yh.nihr.ac.uk.
Disclaimer This report presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the HS&DR programme or the Department of Health. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Service and Delivery Research Programme, NIHR, NHS or the Department of Health.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study received approval from the NHS Research Ethics Committee (REC 3, Health and Care Research Support Centre, Castlebridge 4, 15–19 Cowbridge Road East, Cardiff, CF11 9AB) (REC Reference: 16/WA/0065; Protocol Number: v4.6 SPON1472-15; IRAS Project ID: 192273).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. The data used in the analyses presented here were accessed under license through NHS Digital (England) or NHS Wales Informatics Service. Ambulance service response time data were requested from ambulance services covering intervention and control sites. There are restrictions prohibiting the provision of these data. Interested parties can apply for data from the data owners. By accessing data from the data controllers readers will be obtaining them in the same manner as we did.
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