Frequent attenders to A&E departments: A qualitative study of people who repeatedly present with alcohol-related health conditions

Tom Parkman, Jo Neale, Colin Drummond, Ed Day

Definition

any patient aged 16 or over who attends any

A&E department 10 or more times within a year or 5 or more times within a 3-month period for an alcohol related condition (ISD Scotland, 2011)

Aims and objectives

v Overarching aim: To provide detailed insights into the characteristics, views and experiences of individuals who

repeatedly present to A&E with alcohol-related health conditions in order to optimise the development, implementation and evaluation of interventions for them

v Objectives

1. Understand demographics and social circumstances 2. Drinking/drug patterns 3. Exposure and attitude to services 4. Views on assertive outreach 5. Reasons for A&E attendance 6. Their desired support needs 7. Potential feasibility of future clinical trials with AFAs and engaging them in treatment

v 2 stages

Stage 1

v Participants: 30 AFAs v 4 Hospitals:

v Guys and St Thomas v Kings College Hospital v St Georges v Croydon University Hospital

vQualitative data v Single, Semi-structured interviews will aim to (partially) inform stage 2 v Iterative approach

vQuantitative data v Severity of Alcohol dependence (SADQ), Alcohol Problems Questionnaire

(APQ), Health status (EQ-5D)

Research to date: Stage 1

v Interviewed 13 AFAs in the community v 9 males v 4 females v Age range: 25 63 years v 12 heavily drinking, 1 in recovery (3 months) v 1 has used drugs in the past but never became dependent

v Housing status v 2 homeless v 1 in YMCA v 1 in a wet hostel v 1 living with his mum v 8 living in council housing

v Employment status v All unemployed

v Income v 10 on jobseekers allowance, 2 on Employment and Support allowance (disability benefits), 1 has no

income (living here illegally).

Stage 1: initial findings

v Not based on any in depth analysis BUT some key themes: All have mental health problems Many years of heavy, sustained drinking Most not accessing any service at all. All have physical problems = mobility issues to access services Socially isolated Acutely aware of their own problems but have NO knowledge of services at all (except

A&E). Support for assertive outreach. Frustration at the services they have encountered (GPs, self-help) Laconic and great difficulty articulating their problems Inaccuracies when reporting is what they are saying a version of the truth? Very engrained cycle: drink attend A&E discharge drink Many have positive views about hospital staff (no signs of stigma) BUT several mentioned

that they were discharged very early in the morning and had to get themselves home Received very little/no advice on drinking when in hospital Hospital treat physical problems and never address drinking A&E attendance always precipitated by physical pain. Most call an ambulance.

Research to date: Stage 2

v Single, focus groups with staff and clinicians v Between 6-10 in each FG v 6 chosen hospitals from anywhere in the UK v Stage 2 hospitals:

v Dorset County Hospital (no specialist team) v Hull Royal Infirmary (no specialist team) v University Hospital Birmingham (no specialist team) v Bolton NHS Foundation Trust (specialist team) v Wansbeck General Hospital (specialist team) v Leeds Teaching Hospital (specialist team)

Thank you for listening!

Questions?