Newcastle Alcohol Care and Treatment Service Margaret Orange - - PowerPoint PPT Presentation

Newcastle Alcohol Care and Treatment Service Margaret Orange

Treatment Effectiveness and Governance Manager

Up to 2009 Newcastle had one of the highest ARHA In England Up to 2009 Newcastle had one of the highest ARHA In England

ARHA data ARHA data

• 47 codes
• 13 - Wholly attributable to alcohol
• Remaining – Partially attributable
• National data set – NWPHO
• National Indicator – NI39

Analysing the data Analysing the data

• Hospital Admissions Only – Requested data set
• Postcode/ GP / NHS number
• up to 7 identified codes accepted
• Wholly attributable to alcohol (main focus)

K70 – Alcohol liver cirrhosis F10 – Mental and Behavioural disorder due to alcohol T51 – Alcohol intoxication

Analysing the data Analysing the data

• 1411 admissions -

(707) patients

• Costs = £2.5m
• 943/1411 readmissions (66.8%)
• 239/707 patients readmitted (33.8%)
• 153 males & 86 females
• 468/707 patients admitted once (66.2%)
• age breakdown

Newcastle

Proportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09

<15 <15 15-24 15-24 25-34 25-34 35-44 35-44 45-54 45-54 55-64 55-64 65-74 65-74 75-84 75-84 85+ 85+ 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Newcastle population Newcastle admissions

Segmentation Segmentation -

• understanding

understanding the patient layers the patient layers

• Patients admitted to hospital for 1 day or less (no overnight stay)
• Patients admitted only once
• Patients admitted once for intoxication / patients

re‐admitted for intoxication

• Patients with multiple re‐admissions

for alcohol‐related harm (harmful and dependent drinkers)

• Patients with chaotic lifestyles

accessing hospital services across the 3 PCT/Local Authority areas

• Patients with severe ongoing/end stage illness

Phase 1 Phase 1

Initial target groups

– Patients re-admitted for intoxication – Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers) 20% of patients using over 70% of the costs – Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas North of Tyne 12

Male Female Newcastle 44 49 North Tyneside 22 22 Northumberland 17 25

Example of a Example of a re re-

• admission record

admission record

Codes listed K703 (primary diagnosis) Diseases of the liver F102 Dependence syndrome I10X Hypertensive diseases J459 Chronic lower respiratory diseases R18X Symptoms and signs involving the digestive system and abdomen Z720 Persons encountering health services in other circumstances Z867 Persons with potential health hazards related to family and personal history and certain conditions influencing health status

Example of an Example of an intoxication record intoxication record

Codes listed T40 (primary diagnosis) poisoning by drugs, medicaments and biological substances X620 intentional self harm T51 intoxication/toxic effects of substances non medicinal as to source S099 injuries to head W19 fall F101 harmful use

Needs Assessment Needs Assessment

• Support the tier 3 specialist service
• Build capacity in tier 1 services
• Assessment, clinical interventions, care coordination
• Community/home detox where appropriate
• Alternatives to hospital admission
• Facilitate earlier, planned & coordinated discharge
• Address the NI 39 indicator

• Hospital admissions only
• Wholly attributable fraction
• “frequent fliers”
• Outcome improvement likely
• Reduction in admissions likely

No direct referral route

Reducing hospital admissions Reducing hospital admissions

A partnership approach to;

• Identify alcohol admissions
• Multi agency care

planning meetings

• Care coordination
• Provide alternatives to

hospital admission Community Nurses x2 Assertive Outreach x4.5 Hospital Nurse x1 Mental Health nurse x1

Care Coordination

The role of ACTs The role of ACTs

• Primary Care

Treatment Effectiveness Manager Community Matron Alcohol Nurse Specialist (Primary Care)

• Mental Health Trust

Alcohol Nurse Specialist (Mental Health)

• Acute Hospitals Trust

Alcohol Nurse Specialist (Acute Services)

• Tyneside Cyrenians

X4.5 Assertive Outreach Workers

Multi Multi-

• agency approach

agency approach

Acts Philosophy Acts Philosophy

• Long term condition philosophy
• Community Matron Model
• Advanced clinical skills
• Medicines management
• Innovative case management (MAMs)
• IBA Strategy

Community Matrons

Community Matrons promote and provide care at home with the aim of avoiding, where at all possible repeated hospital admissions. Community matrons work with patients who are:

• Experiencing long term illnesses
• Over 18
• May benefit from early hospital discharge
• Have had repeated hospital admissions

Your GP may ask the Community Matron to contact you to offer you support if any of these issues apply to you. They can:

• Meet with you and find out how they can help you to be as well as possible.
• Make plans with you to achieve this. Involve your family or carer if you would like this.
• As part of the plan liaise with others involved with your care.

Newcastle Alcohol Care and Treatment Service Imelda O’Mahony

Community Matron

Background Background

• Pre – acts

– 7 ARHA in 7 months

• Codes

– T51 intoxication – F10 harmful use – K70 alcoholic liver disease

Challenges Challenges

• Ambivalent use of alcohol
• Mental health history
• Social anxiety
• Deteriorating physical health
• Family/relationship difficulties

Acts involvement Acts involvement

• Assessed at GP practice
• Multi-agency meetings
• Seen 3x per week
• Exploration of ambivalence
• Monitor physical health
• Props referral
• Mental health referral
• Introduction to recovery services

Current Situation Current Situation

• Continued ambivalence
• Ongoing support

– Physical wellbeing – Attendance at hospital appointments – Psychotherapeutic support

• Considering the use of rehab
• 6 ARHA in 14 months

Newcastle Alcohol Care and Treatment Service Lorraine Hussain

Alcohol Nurse Specialist

Background Background

• Pre – acts

– 4 ARHA in 14 months – Drinking 4 litres of 7.5% cider (30 units daily)

• Codes

– F10 harmful use – K70 alcoholic liver disease

Challenges Challenges

• Significant health issues

– Requires hip replacement – Oesophageal Varisces

• Lives alone
• Vulnerability

ACTS INVOLVEMENT ACTS INVOLVEMENT

• GP liaison
• Multi-agency meetings
• Seen three times a week by team.
• Slow reduction planning with intensive support
• Psychotherapeutic work
• Referral to Occupational Therapy
• Referral to Physiotherapy
• Referral to recovery centre
• Physical activity
• Social support

– Money management – Appointment attendance

Current Situation Current Situation

• Current consumption - 1 pint of 7.5% daily
• Fear of sobriety
• Triggers

– Sport – Family

• Awaiting surgery (6months)
• Vulnerable adult
• 1 ARHA in 6 months

Newcastle Alcohol Care and Treatment Service

Up to 2009 Newcastle had one of the highest ARHA In England Up to 2009 Newcastle had one of the highest ARHA In England

5 . 6 % 1 7 . % 1 6 . 2 % ‐ 5 . 9 % 1 . 9 % 5 . 9 % 9 . 2 % 1 5 . 3 % 5 . 5 % 1 1 . % 6 . 3 % 1 2 . 6 % 2 1 . 7 % 9 . 1 % 1 2 . 2 % 7 . 4 % 1 9 . 7 % 6 . 1 % 1 1 . 2 % 8 . 7 % 1 3 . 6 % 1 5 . 9 % 7 . 4 % 1 . 7 % ‐ . 1 % 1 . 4 % . % ‐ 1 . 3 % ‐ 1 . 6 % 1 . 6 % ‐ 2 . 8 % ‐ 1 . 2 % 1 2 . 9 % ‐ . 3 % . 6 %

H A R TLEP O O L C O U N TY D U R H A M D A R LIN G TO N G A TE SH EA D M ID D LESB R O U G H N E W C A STLE N O R TH TEES

8 . 7 % 7 . 3 % 1 4 . 8 % 1 5 . 3 % 9 . 1 % 6 . 9 % 1 3 . 7 % 9 . 6 % 1 4 . 6 % 1 8 . 3 % 9 . % 9 . 7 % 1 . 3 % 1 1 . 2 % 1 5 . 3 % 8 . 9 % 9 . 3 % 8 . % 1 1 . % 1 3 . 1 % 8 . 3 % 8 . 5 % 6 . 6 % 5 . 4 % 1 3 . 2 % 1 2 . 4 % 7 . 9 % 8 . 1 % 1 . 1 % 8 . 8 % 1 2 . 7 % 8 . 7 % 1 . 5 % 7 . 5 % 6 . 6 %

08/09 ‐ 09/10 Annual Change 09/10‐10/11 Q1 Change 09/10‐10/11 Q1‐Q2 Change 09/10‐10/11 Q1‐Q3 Change 09/10‐10/11 Q1‐Q4 Change

N O R TH TY N ESID E N O R TH U M B ER LA N D R ED C A R & C LEV ELA N D SO U TH TY N ESID E SU N D ER LA N D N O R TH EA ST EN G LA N D

2009-10 - 2010/11 Q1-Q4 and 2009/10 Quarterly change in alcohol related hospital admission

1,843 2,003 2,016 2,244 2,465 2,615 2,748 2,585 2,578 1,216 1,352 1,535 1,749 1,898 2,046 2,251 2,406 2,597 925 1,022 1,144 1,290 1,384 1,473 1,582 1,743 1,884 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

Newcastle North East England

21st 12th 2nd 2nd 3rd 2nd 1st 1st 1st Ranked nationally:

Actual rate of ARHA:

Age Admissions pre-ACTs Admissions post-ACTs 36 22 admissions over 24months 1 admission over 3months 54 17admissions over 23 months 1 admission over 6 months 35 6 admissions over 18 months 0 admissions over 14 months 42 30 admissions over 24 months 0 admissions over 3 months 40 4 admissions over 12 months 4 admissions over 19 months 57 4 admissions over 14 months 1 admissions over 6 months 56 12 admissions over 16 months 0 admissions over 8 months 42 30 admissions over 24 months 0 admissions over 3 months 42 12 admissions over 24 months 6 admissions over 21 months 41 2 admissions over 18 months 4 admissions over 9 months

So Why does it work? So Why does it work?

• The Service

– Philosophy – Flexibility – Skill base

• The client

– Relationship – Coordination of care – Skill base

To come: formal evaluation and research