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Intervening to reduce alcohol related hospital admissions

Intervening to reduce alcohol related hospital admissions. Robert Anderson, Economic Adviser Health Improvement Analytical Team. Alcohol strategy in place to reduce alcohol related harms Regulation – restrictions on advertising Price – tax, minimum price per unit, restricting promotions

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Intervening to reduce alcohol related hospital admissions

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  1. Intervening to reduce alcohol related hospital admissions Robert Anderson, Economic Adviser Health Improvement Analytical Team

  2. Alcohol strategy in place to reduce alcohol related harms Regulation – restrictions on advertising Price – tax, minimum price per unit, restricting promotions Time profile of effects – some immediate, others longer term. Working in background – not much PCTs can do in these areas Alcohol Strategy and PCTs

  3. Alcohol strategy in place to reduce alcohol related harms Regulation – restrictions on advertising Price – tax, minimum price per unit, restricting promotions Time profile of effects – some immediate, others longer term. Working in background – not much PCTs can do in these areas Alcohol Strategy and PCTs

  4. Yet short term targets for admissions. Precedents – other areas where PCTs confronted with targets they have to fulfil Health inequalities: to reduce by 10% the life expectancy gap between the Spearhead and the country as a whole by 2010. Natural local version of target: gap between PCT and England Drew up list of interventions PCTs could deliver Quantified effect on target, eg if prevalence of secondary therapy for CVD could be increased by x percentage points, squeeze on gap would be y%. Developed tool specific to local area Widely extolled, but less sure if widely used. Alcohol Strategy and PCTs

  5. Key ingredients of health inequalities tool Information as to pattern of local problem – partitioning by age and disease local target Interventions the PCT can mount Local discretion as to portfolio of interventions Within timescale of target Results directly applying to local area Web based tool hosted by LHO Floating estimate – effect compared with what would otherwise have happened Apply these principles to alcohol target Alcohol Strategy and PCTs

  6. Interventions with rapid effect on admissions: A&E nurse (St Mary’s) Screening in primary care using AUDIT protocol followed by brief intervention for selected subjects (TrEAT) Dependent drinkers social behaviour and network therapy; also variant motivational enhancement therapy (UKATT) Alcohol Strategy and PCTs

  7. Effectiveness established by follow up and reported in peer reviewed literature No stretched chain of evidence Details of the intervention available from reports of trials: UK Alcohol Treatment Trial (UKATT) Trial for Early Alcohol Treatment (TrEAT) St Mary’s Estimates of outlay and monetised reduction in A&E/inpatient admissions The interventions - advantages

  8. However, some less certain areas: Extrapolation from US setting (TrEAT) Extrapolation from more intensive intervention (TrEAT) Impact on admissions (St Mary’s) based on proportion of A&E visits resulting in admission Conversion of bed days to admissions (Treat, UKATT) Average cost of an admission No estimate of front end set up costs No guarantee that admissions saved will show up as alcohol relatedOther benefits – crime, health – not included Interventions

  9. Provides background data and context for any selected PCT Allows comparison of this data with any other PCT Shows effect on trajectory Tool straightforward compared with health inequalities tool (analytical engine) but no suggestion that problem is easy to solve Needs refinement The tool (analytical engine)

  10. Tool – front page template not yet released

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