Transcript www.alcohollearningcentre.org.uk

A Social Marketing Approach to the
‘wicked’ problem of alcohol
Newcastle upon Tyne
North Tyneside
Northumberland
Lynda Seery
Public Health Lead for Substance Misuse
Starting point – available datasets
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Hospital Episode Data - detailed
A&E data - limited
Crime data
Service data
Strategic Assessment data
Health Needs Assessment data
Social Care Data
– Incapacity benefits
– Housing data
– Supported Housing data
Admissions data vs A&E data
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There is a need to distinguish between the 2 sets of data – differences
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A&E attendance (i.e. injury, intoxication, physical problem)
– Primary diagnosis
– Contributory factor i.e. alcohol (coding issues)
– Differing requirements of the data – i.e. cross referencing to
crime/violence
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Admitted to hospital – specific vs related alcohol admissions
– Primary diagnosis
– Conditions which arise or are further identified during hospital spell
(coding)
• Mental health & behavioural disorders due to alcohol related
harm
• Intoxication
• Cirrhosis of the liver
• Pancreatic disease
Can be numerous codes during hospital stay
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Analysis of hospital admissions
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complex indicator
requested dataset 1/7/2007 – 30/9/2009
all admissions within ‘specific’ set of codes
Highest number of admissions in these 3
categories
– F10 mental & behavioural disorders due to
alcohol
– K70 alcoholic liver disease
– T51 intoxication
HES Records
• postcode level
• Specific codes - wholly attributable to
alcohol (main focus)
• 1411 admissions (707) patients
• between 141 – 202 admissions each qtr
• 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
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
Target groups
• Initial target groups
– 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
North of Tyne 20
Establishment of Community
Alcohol Teams
What will Community Alcohol teams provide?
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Service primarily focused on service provision within the community setting,
building capacity in tier 2 and enhancing tier 3 provision of specialist
services
Community / home detox support being developed (as appropriate)
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Assessment, expert clinical advice, managing health risk for those
individuals with a dominant single condition i.e. alcohol
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Establishment of Community Open Clinics – development of ‘wrap-around’
services (provide monitoring of physical and mental health, alcohol
counselling, assessment and advice regarding relapse prevention)
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Partner presence at Community Open Clinics: social care worker, housing
advice, benefits advice, assertive outreach to support attendance at clinics.
Venues will vary across the city - targeted areas across the city
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The establishment of a regular Community Open Clinic at Cyrenians work
with vulnerable individuals with alcohol related problems including those
experiencing social exclusion
Key areas of development
• Multi agency care plans
– (individuals may have a single dominant condition i.e. alcohol but
may be known to different agencies)
• 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
• Emerging workforce (i.e. new roles, liaison, co-ordination,
systems approach to service delivery)
• A&E – Alcohol Liaison Workers
• Wider use of IBAs (pragmatic approach - multi
agency training)
BROADENING THE BASE OF “TREATMENT”
FOR ALCOHOL PROBLEMS
• Most important change in treatment of alcohol problems over last
10-20 years: focus of intervention broadened from just “alcoholics”
to much larger number of “excessive drinkers” (i.e., hazardous and
harmful drinkers).
• Sufficient number of excessive drinkers show progressive
deterioration to make early intervention and secondary prevention
an essential part of national response to alcohol-related harm. Such
an approach is likely to be highly cost-effective.
• For many types of problem, the major contribution to alcohol's costs
to society comes from drinkers with less frequent and serious
problems, cf. “the preventive paradox”
Community Open Clinics
– Professionals available at clinics, clinical &
mental health staff, social care, housing,
benefits
• Locations
– City/Town centres
– Community centres
– Universities
– ‘Peoples Kitchen’ (Newcastle)
– Shopping Centres
How long will it take us to impact on our target?
Reducing the harm from alcohol Alcohol-harm related hospital admission rates (NI 39)
Lead time for achieving outcomes & impacting on alcohol target
Gestation from input to outcome
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Treatment – Integrated service approach to those
individuals admitted to hospital
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Treatment – Integrated service approach to those individuals admitted to hospital or
those suffering from alcohol misuse
Brief & Extended Interventions
Heavier enforcement
Social Marketing - initiatives
Prevention – education & communication
Sensible drinking campaigns
2010
2015
2020
2025
How hard can it be?
•Pace
•Purpose
•Passion
Questions?