Transcript Trend in alcohol related admissions in

LETS TACKLE THE ELEPHANT:
UK ALCOHOL EPIDEMIC
Dr Johannes Coetzee
Bridge Lane Group Practice 29.11.2010
Professor Nutt says
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Alcohol causes more
widespread harm than
drugs like heroin or crack
cocaine, according to a
study published in
respected medical journal
The Lancet.
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5:01pm UK, Monday
November 01, 2010
Graham Fitzgerald, Sky News
Online
Let's Tackle the Elephant
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Alcohol 50% more affordable
Alcohol related harm is underestimated and
continues to spiral
25% of population are hazardous, harmful or
dependent drinkers
13 children a day are hospitalised as a result of
alcohol misuse
More people die from alcohol related causes than
from breast cancer, cervical cancer and MRSA
combined
Costs attributable to alcohol misuse
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£18-£25bn a year
 Alcohol
related disorders and disease
 Crime and anti-social behaviour
 Loss of productivity in the workplace
 Impact on families and burden on the NHS
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Financial burden on the NHS is £2.7bn a year
 863
000 admissions per year
Trend in alcohol related admissions in
England
Co-morbidity
Men >8 units per day
Women>6 units per day
Condition
Men (increased risk)
Women (increased risk)
Hypertension
Four times
Double
Stroke
Double
Four times
CHD
1.7 times
1.3 times
Pancreatitis
Triple
Double
Liver disease
13 times
13 times
Co-morbidity
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Psychiatric co-morbidity is common among problem
drinkers
 Up
to 10% for severe mental illness
 Up to 50% for personality disorders
 Up to 80% for anxiety and depression
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There are links between high levels of youth
consumption and other risk factors such as youth
offending, teenage pregnancies, truancy, exclusion
and illegal drug use but the precise nature is not
fully understood
Family Williams
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Mrs Williams – depressive episode
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Master Williams
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12 year old son behavioural problems
Financial worries
Relationship breaking down
Truancy
Angry with father – “moody”
Mr Williams
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Successful executive – high levels of stress
Poorly controlled blood pressure and diabetes
Drinking has increased over the past 12 months
Audit C score 36
Family Williams
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Alcohol Misuse should not be seen in isolation
Issues arising:
 Domestic
Abuse
 Impact on the family
 Child protection issues
 Truancy, Risk of exclusion
 Potential loss of productivity
 Mental well being of Mrs Williams
 Mental and physical well being Mr Williams
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Risk of CHD and stroke for example
What are the current gaps in alcohol
treatment services?
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Needs assessment
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Most PCT’s do have a strategy for alcohol harm or have carried out a local
needs assessment
Screening
What are the challenges of screening?
Who do we screen?
Universal or Targeted screening?
Quality and effectiveness of screening?
Low cost, high impact, measureable outcomes
Few LES for screening in existence
Lack of specialist nurse support
Under resourced treatment services
Long waiting times to treatment
What are the current gaps in alcohol
treatment services?
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Links between services
 Poor
liaison or integration between acute services and
follow-on and support in the community
 Huge gaps between acute detoxification and
community addiction services, in addition long waiting
times between treatment for alcohol withdrawal
symptoms and addiction services input
What is the current funding situation
for alcohol treatment?
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Budget for 2009/2010 was £406 million
NAO report – PCT’s 0.1% of budget (£600k)
 £197
per dependent drinker per year
 £1744 per drug dependent patient per year
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UKATT study suggests that for every £1 spend on
treatment, the public sector saves £5
What models work best for Primary
Care?
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IN 2008/09 NHS Wandsworth undertook a 12 month
pilot designed to indentify the most cost and clinically
effective model for delivering treatment for alcohol
dependency within the primary care setting
Model A:
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LES agreement for screening, brief interventions and
treatment
Model B:
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GP led, structured community treatment programme
Model A
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LES self selecting consisting of 6 Practices
Screening the practice population and the offering
of alcohol detoxification in primary care
All practices were required to attend training in the
management of alcohol withdrawal
All practices had access to specialist nurse support
Model B
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Fresh Start Clinic
Branding – to remove stigma and increase uptake to
treatment
GP (RCGP diploma) and Specialist Nurse Prescriber
Operating principles - specialist treatment services
Offers planned alcohol withdrawal within pre-agreed
structured treatment plan
Daily attendance, breathalysing , dispensing
Abstinence prescribing offered
Follow-up key working sessions and an open group are
offered with signposting to After Care
Follow-up at 3 months
Outcomes
Model A (LES)
Model B (Fresh Start)
Number of Rx episodes
6
76
Quality
Difficult to assess
Positive Pt feedback
Outcomes
Uncertain
100% Completion Rate
57% abstinence at 3-6/12
50% improvement in BDI
Improvement GGT and
MCV
Relapse/Re-engage
Waiting time to Rx – 7/7
CAT waiting time (18-4/52)
↓ETOH related absence
Cost
£466/Rx episode
£206/Rx episode
↓Re-treatment
Who would GP’s see as potential
Partners?
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Any partnership will need to commission for
outcomes
Emphasis on screening and the prevention of alcohol
dependency
Foster relationships with Acute Care, Mental Health,
Care of the Elderly and Criminal Justice
Who would GP’s see as potential
Partners?
White Paper
White Paper
White Paper
Think Family Williams
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Thank you
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Johannes Coetzee
[email protected]