Project overview
Alcohol causes over 60 different physical, and mental health conditions. In England, more people are being admitted to hospital and dying from alcohol-related disease than ever before. We know much about what helps people with severe alcohol dependence who go to specialist addiction services, but much less is known about the 1 in 10 people admitted to acute hospitals who are also AD, but not necessarily seeking treatment. As patients may come into hospital for a wide range of other reasons, their alcohol use is often not recorded, missing opportunities to help empower them to make changes needed to improve their health. Alcohol Care Teams (ACT) have gradually developed in response to local need, but all in different ways. As part of the National Health Service (NHS) long-term plan, a structure and set of competencies to deliver these services have been defined, and ACT are being developed in 25% of hospitals with the greatest need. The next step is to understand which models are most effective, how they are perceived by patients, and if they are a good use of NHS resources in helping improve outcomes and reduce health inequalities. We have designed a programme that will help answer these questions to inform policy decisions about the next steps for ACT. We will start by mapping the ACT provision across the country, then develop a way of categorising all the different kinds of work that an ACT does and get agreement on what these are so that teams can all use the same language to describe what they do, enabling them to be directly compared. We will then use data from several sources, to look at the impact of different kinds of ACT on hospital admissions with alcohol dependence. As outcome data are not routinely collected, we will also recruit patients from different hospital sites to get actual patient-level follow-up data after six-months to record any changes in alcohol consumption, general health and wellbeing and NHS hospital use. Given the different stages of development of ACT, this will be a real-world experiment across six hospital sites, to help us identify what works best, for whom. Estimating costs of different ACT and how they relate to patient outcomes will help inform which are the best value for the NHS. As alcohol dependence is a condition about which many people feel a great deal of shame, and there are no large patient-led charities to drive the research agenda in this area, we have included patient and public co-production as central to our research plan. We will include a strong qualitative evaluation and use hospital case-studies, and interviews with decision makers, staff and patients to understand the challenges for ACT at national, regional and local level. We will bring together the results of different strands as they emerge to best inform the next stage of the research as well as the final recommendations. This programme will enable us, for the first time, to define the necessary components of an ACT, where and how they work best, and with which group of patients. It is the start of growing the evidence base for which interventions are most helpful in this under-served patient group. Central to this is the development of an ACT patient and public involvement network, which is currently lacking, as well as providing evidence and tools to policy makers and commissioners about the best use of NHS funds in this area by the end of the current programme.
