Co-production evaluation of the County Durham Alcohol Hospital Liaison Team (AHLT)

Title: Co-production evaluation of the County Durham Alcohol Hospital Liaison Team (AHLT) (in association with FUSE) Background (250): County Durham has higher than average hospital admissions for alcohol use, costing £212 million per year. The royal college of physicians recommends hospitals have specialised alcohol care teams which should be evaluated for effectiveness. Aims (250): The primary aim was to assess the effectiveness of the AHLT at reducing alcohol specific hospital admissions for a cohort of patients. A secondary aim was to gain feedback on the service from clients and staff to shape future commissioning. Methods (600): A mixed methods approach was used for this evaluation. For the primary aim, admission records for the cohort for a period of 6-months prior to engaging with the AHLT were compared with admissions recorded whilst working with the AHLT and any admissions for a period of 6-months after discharge by the AHLT. A short survey was sent to clients to gain feedback on their experience of the AHLT. Furthermore, two-clients were identified who participated in an interview to provide more in depth feedback on the service. Finally a focus group was conducted with staff who work for the AHLT to gain feedback in the service from the providers perspective. Results (600): There is a small reduction in hospital admissions when comparing pre-engagement with the period after discharge; however admissions increased significantly whilst engaged with the AHLT compared to pre-engagement. Furthermore, A&E attendances increased slightly when comparing pre-engagement with the period after discharge; attendances increased significantly whilst engaged with the AHLT compared to pre-engagement. Clients were satisfied with the service and felt working with the AHLT had impacted on their drinking. AHLT staff reported feeling isolated, and that hospital staff relied on them for providing brief advice. Conclusions (600): It is not possible to say that the fluctuation in admissions was due to engagement with the AHLT. However, A&E attendances have continued to rise after engagement with the AHLT, whilst admissions decreased, suggesting that there has been some impact on alcohol specific admissions. Feedback survey and focus group results indicate there may be an over reliance on the AHLT to provide detox medication. Future services should be designed to work with people who are frequent A&E attenders who have not developed chronic health conditions; provision of brief advice should have strong clinical leadership within the hospital. Expected Learning Outcomes (400): We know that providing brief advice in secondary care can reduce drinking, however as only 50% of this cohort seems to have been advised to reduce drinking, this still does not appear to have been routinely accepted into practice. REWORD A mixed methods approach was used for this evaluation. For the primary aim, admission records for a cohort of 167 clients for a period of 6-months prior to engaging with the AHLT were compared with admissions recorded whilst working with the AHLT and any admissions for a period of 6-months after discharge by the AHLT. A short survey was sent to clients to gain feedback on their experience of the AHLT. Finally a focus group was conducted with staff who work for the AHLT to gain feedback in the service from the providers perspective The evaluation used a co-production model involving researchers from Teesside University and Public Health Staff from Durham County Council who were involved in all aspects of the evaluation from designing the protocol to analysing and disseminating results.