Transcript Slide 1

The ‘wicked’ problem of alcohol
- insights from the data
Newcastle upon Tyne
North Tyneside
Northumberland
Lynda Seery
Public Health Specialist
Starting point – what do we know?
(Nationally)
Needs Assessment
• National Indicator set –
NWPHO
• Hospital admissions for
Alcohol-related harm:
Understanding the
dataset
Service Review
• Models of Care for Alcohol
Misusers (MoCAM)
• Effectiveness review
• QuADS, DANOS
• HubCAPP,
www.alcohollearningcentre.org.uk
• National Alcohol Treatment
Monitoring System
• The Alcohol Needs
Assessment Research
Project (ANARP)
Top priority – do we know what is
happening locally?
a) Local Needs Assessment?
b) Multiple strategies across the patch (all at various stages)
- Prevention
- Early intervention and treatment
- Enforcement and control
- Partnership
c) Local Service Review?
How are we measuring progress?
- Are we using effective measures?
- Short, medium and long term impact – where does the evidence lie?
- Alcohol-related hospital admissions
Analysis of hospital admissions
• complex indicator
• requested dataset 1/7/08 – 31/3/09
• all admissions with any of the 3 codes
identified within the spell of care
(not necessarily primary diagnosis)
– F10 mental & behavioural disorders due to
alcohol
– K70 alcoholic liver disease
– T51 intoxication
Individual patient record
• postcode level
• up to 7 identified codes accepted (but some patients have up to
14 attached codes)
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1.00 - 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
Phase 1
• 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 20
– Patients with chaotic lifestyles accessing hospital services
across the 3 PCT/Local Authority areas
North of Tyne 12
Mapping the services and initiatives
• Tier system
– MoCAM (Models of Care for Alcohol Misusers)
– Prevention/Early Intervention – implementing
IBAs (across primary care & multi agency)
– Treatment – Community services & emerging
alcohol workforce
• Virtual team working across primary care, mental health,
acute services, social care, voluntary sector,
– Enforcement – management of environment &
night time economy
• requires more cohesiveness and connectivity with community
services
– Rehabilitation – very small numbers
– Care Pathway
Improvement methodology
• 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
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Assertive Outreach
STR workers (Support, time and recovery workers)
Wider use of IBAs (multi agency)
Emerging workforce (i.e. new roles, liaison, co-ordination,
systems approach to service delivery)
• Flexible approach, learning (i.e. PDSA cycles)
Repeated use of the PDSA cycle
Changes that
result in
improvement
Spread
Hunches
Theories
Ideas
A
S
P
Implementation of Change
D
Wide scale tests of change
Follow up tests
Very small scale test
Sequential building of
knowledge under a wide
range of conditions
PDSA stage
• PDSA cycle 1
– hospital admission analysis
– learning has allowed us to ask more questions
• PDSA cycle 2
– We have filtered through the records and have taken a layer to
examine more closely so we are now beginning the process of
assessing the actual records of individuals with multiple
admissions to determine those patients who may benefit from
more joined up multi agency services
Future work – focused/targeted work
• development of a whole system approach to alcohol related
harm - multi stranded work
• establish a North of Tyne Care Pathway
• community services established and adapted to meet the
need - targeted work (demographics already known)
• working up from granular level up into communities has the
highest potential for positive impact
• multi agency training – raise awareness, develop skills and
competencies
• systematic, cohesive approach across locality and wider
geographic area
How hard can it be?
•Pace
•Purpose
•Passion
Questions?