Alcohol Medical Intervention Clinic: A Rapid Access Addiction Medicine Model Reduces Emergency Department Visits.
Journal
Journal of addiction medicine
ISSN: 1935-3227
Titre abrégé: J Addict Med
Pays: Netherlands
ID NLM: 101306759
Informations de publication
Date de publication:
Historique:
pubmed:
14
8
2019
medline:
17
6
2021
entrez:
13
8
2019
Statut:
ppublish
Résumé
Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system. Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed. For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001). AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.
Identifiants
pubmed: 31403977
doi: 10.1097/ADM.0000000000000559
pii: 01271255-202004000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
163-171Commentaires et corrections
Type : CommentIn
Références
Academic ED SBIRT Research Collaborative. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med 2007; 50:699–710.
Babor TF, Higgins-Biddle JC, Saunders JB, et al. AUDIT: The Alcohol Use Disoders Identification Test: Guidelines for Use in Primary Health Care. 2nd ed. Geneva, Switzerland: World Health Organization; 2001.
Brandish E, Christopher O, Sinclair J. Acute management of alcohol and other drug problems. Medicine (Baltimore) 2017; 45:1–6.
Canadian Institute for Health Information. (2017). Alcohol Harm in Canada: Examining Hospitalizations Entirely Caused by Alcohol and Strategies to Reduce Alcohol Harm. Available at: https://www.cihi.ca/sites/default/files/document/report-alcohol-hospitalizations-en-web.pdf. Accessed June 24, 2018.
Canadian Substance Use Costs and Harms Scientific Working Group. (2018). Canadian substance use costs and harms (2007–2014). Ottawa, Ontario. Available at: http://www.ccdus.ca/Resource Library/CSUCH-Canadian-Substance-Use-Costs-Harms-Report-2018-en.pdf. Accessed June 24, 2018.
D’Onofrio G, Degutis L. Integrating Project ASSERT: a screening, intervention, and referral to treatment program for unhealthy alcohol and drug use into an urban emergency department. Acad Emerg Med 2010; 17:903–911.
Dennis ML, Feeney T, Stevens LH, et al. Global Appraisal of Individual Needs Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-SS Version 2.0.1. Bloomington, IL: Chestnut Health Systems; 2006.
Government of Manitoba. (2018). Rapid Access to Addictions Medicine Clinics Open in Beandon and Thompson. Available at: https://news.gov.mb.ca/news/index.html?item=44694. Accessed March 22, 2019.
Health Canada. Apparent Opioid-related Deaths. Ottawa, Ontario; 2018. Available at: https://www.canada.ca/en/health-canada/services/substance-abuse/prescription-drug-abuse/opioids/apparent-opioid-related-deaths.html. Accessed June 28, 2018.
Klein L, Martel M, Driver B, et al. Emergency Department frequent users for acute alcohol intoxication. West J Emerg Med 2018; 19:398–402.
Krieg C, Hudon C, Chouinard M, et al. Individual predictors of frequent emergency department use: a scoping review. BMC Health Service Res 2016; 16:594.
Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. JGIM 2001; 16:606–613.
LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med 2010; 56:42–48.
Larsen D, Attkisson C, Hargreaves W, Nguyen T. Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann 1979; 2:197–207.
Lillico H. META:PHI– How One Initiative is Increasing Access to Evidence-Based Treatments for Substance Use Issues; 2017. Available at: https://eenet.ca/sites/default/files/pdfs/Evidence in Action_metaphi_0.pdf. Accessed February 18, 2019.
Moe J, Kirkland S, Rawe E, et al. Effectiveness of interventions to decrease emergency department visits by adult frequent users: a systematic review. Acad Emerg Med 2017; 24:40–52.
Mullins PM, Mazer-Amirshahi M, Pines JM. Alcohol-related visits to US emergency departments, 2001–2011. Alcohol Alcohol 2017; 52:119–125.
Ogrinc G, Davies L, Goodman D, et al. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016; 25:986–992.
Parkinson K, Newbury-Birch D, Phillipson A, et al. Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study. Emerg Med J 2016; 33:187–193.
Public Health Ontario. Opioid-related morbidity and mortality in Ontario: The Interactive Opioid Tool; 2018. Available at: https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx. Accessed June 15, 2018.
RAAM Clinics. Available at: https://www.metaphi.ca/raam-clinics/. Accessed February 15, 2019.
Rush B, Urbanoski K, Bassani D, et al. Prevalence of co-occurring substance use and other mental disorders in the Canadian population. Can J Psychiatry 2008; 53:800–809.
Schuler M, Puttaiah S, Mojtabi R, et al. Perceived barriers to treatment for alcohol problems: a latent class analysis. Psychiatr Serv 2015; 66:1221–1228.
Skinner HA. The drug abuse screening test. Addict Behav 1982; 7:363–371.
Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166:1092–1097.
Stockwell T, Murphy D, Hodgson R. The severity of alcohol dependence questionnaire: its use, reliability and validity. Br J Addict 1983; 78:45–58.
Verelst S, Moonen P-J, Desruelles D, et al. Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol Alcohol 2012; 47:433–438.
White AM, Slater ME, Ng G, et al. Trends in alcohol-related emergency department visits in the United States: results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcohol Clin Exp Res 2018; 42:352–359.
WHO ASSIST Working Group. The Alcohol, Smoking, and Substance Use Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction 2002; 97:1183–1194.
Willmore J, Marko TL, Taing D, et al. The burden of alcohol-related morbidity and mortality in Ottawa, Canada. PLoS One 2017; 12:1–19.