Transcript Slide 1

The ‘wicked’ problem of alcohol
Newcastle upon Tyne
North Tyneside
Northumberland
Lynda Seery
Public Health Lead for
Drug and Alcohol
What we did in 2007?
• Nationally
» information, data (NWPHO), evidence
» MoCAM,
» the Alcohol Needs Assessment Research Project
(ANARP)
• Locally
» Strategies?
» Needs Assessment ?
» Service Reviews?
• Mapping of service provision
What we found?
• Tier 1 - Prevention
» C&YP – Healthy Schools module
» Adults – national campaigns only
• Tier 2 –Treatment
» Community services
• Tier 3 – Treatment (specialist)
» Specialist addictions service (detox available)
» A&E
» Admission to hospital
• Tier 4 – Residential rehab
» Assessment against criteria (predominantly for
drugs)
» Structured day care
How do we impact on the
indicator?
• complex indicator
• requested data extract 1/4/07 – 31/3/09
• 3 particular hospital codes of interest identified
within the spell of care
(not necessarily primary diagnosis)
– F10 mental & behavioural disorders due to alcohol
– K70 alcoholic liver disease
– T51 intoxication
• 1.00 - wholly attributable to alcohol (main focus)
Individual patient record
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postcode level & GP Practice
1411 admissions (707) patients
Costs = £2.5m
943/1411 re-admissions (66.8%)
239/707 patients readmitted (33.8%)
2 to 1 male to female split
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
100.0%
85+
75-84
90.0%
65-74
85+
75-84
65-74
55-64
80.0%
55-64
70.0%
45-54
45-54
60.0%
35-44
50.0%
25-34
35-44
40.0%
30.0%
15-24
20.0%
25-34
10.0%
<15
0.0%
Newcastle population
15-24
<15
Newcastle admissions
North Tyneside
Proportion of population in each age group. North Tyneside population as a whole and North Tyneside admissions
100.0%
85+
75-84
85+
75-84
65-74
90.0%
65-74
55-64
80.0%
55-64
70.0%
45-54
45-54
60.0%
50.0%
35-44
40.0%
35-44
25-34
30.0%
15-24
20.0%
10.0%
<15
0.0%
North Tyneside population
25-34
15-24
<15
North Tyneside admissions
Northumberland
Proportion of population in each age group. Northumberland population as a whole and Newcastle admission 1/4/07 - 31/3/09
100.0%
85+
85+
75-84
75-84
65-74
90.0%
65-74
80.0%
55-64
55-64
70.0%
60.0%
45-54
45-54
50.0%
35-44
40.0%
25-34
30.0%
20.0%
35-44
15-24
25-34
10.0%
<15
15-24
0.0%
Northumberland population
<15
Northumberland admissions
Segmentation - understanding the patient
layers
The ‘patient layers’ fall into the following categories:
• Patients admitted to hospital for 1 day or less (no
overnight stay)
• Patients admitted only once
• Patients admitted once for intoxication / patients readmitted for intoxication
• Patients with multiple re-admissions for alcoholrelated 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
Patients admitted once only for 1 day or 8 hours or less
Admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09
(patient admitted once for 1 day or less)
Stomach or Duodenum Disorders
Ingestion Poisoning or Allergies
100%
90%
Epilepsy
80%
Syncope or Collapse
70%
Gastrointestinal Bleed
60%
Sprains, Strains, or Minor Open Wounds
50%
40%
Chronic Pancreatic Disease
30%
Chest Pain
20%
General Abdominal Disorders
10%
Poisoning, Toxic, Environmental
0%
New castle PCT
North Tyneside PCT
Northum berland CT
Example of intoxication record
Codes listed
T40 (primary
diagnosis)
poisoning by drugs, medicaments and
biological substances
X620
intentional self harm
T51
S099
intoxication/toxic effects of substances
non medicinal as to source
injuries to head
W19
fall
F101
harmful use
‘Frequent users’ or re-admissions to hospital
Re-admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09
(239 frequent users accounting for 943 admissions )
Stomach or Duodenum Disorders
Gastrointestinal Bleed
100%
90%
Chronic Obstructive Pulmonary
Disease or Bronchitis
80%
General Abdominal - Diagnostic
Procedures
70%
Pancreatic Disorders
60%
Drainage of Ascites
50%
Poisoning, Toxic, Environmental
40%
General Abdominal Disorders
30%
Chronic Liver Disorders
20%
Chronic Pancreatic Disease
10%
0%
Newcastle PCT
North Tyneside PCT
Northumberland CT
Example of re-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
Phase 1 – focused work with identified
• Target groups
individuals
– patients re-admitted for intoxication
Male
Female
Newcastle
44
49
North Tyneside
22
22
Northumberland
17
25
- Patients with multiple re-admissions for alcohol-related harm
(harmful and dependent drinkers)
Significant 60
– Patients with chaotic lifestyles accessing hospital services
across the 3 PCT/Local Authority areas
Significant 12
Community Alcohol team (virtual)
• Treatment Effectiveness & Governance
Manager
• Community Matron for Social Exclusion
(alcohol)
• Nurse Practitioner
• x2 Alcohol Specialist Nurses (mental health)
• X2 Alcohol Specialist Nurses (acute)
• 4.5 wte Assertive Outreach Workers
• x1 IBA Trainer (+2 sessional trainers)
• x1 Health Link Worker (A&E)
What the team provides
• Care Co-ordination – key worker responsibility
• Multi agency care plans
– (individuals may have a single dominant condition i.e. alcohol but
may be known to different agencies)
• Community Matron post – key to working with GPs
and into Practices
• Community Open clinics (walk in, self refer, referred into
from any other service)
– Professionals available at clinics, clinical & mental health staff,
social care, housing, benefits
• Assertive Outreach (voluntary sector)
• Wider use of IBAs & Brief Interventions (multi
agency training – confidence & competence)
• Implementation of the Cardiff Model – A&E & CDRP
How hard can it be?
•Pace
•Purpose
•Passion
Questions?