Abstract
Abstract
Background Diamorphine Assisted Treatment (DAT) is an alternative treatment modality for people who do not benefit from standard treatment (opioid substitution treatment [OST]). Middlesbrough, a town in the North-East England, was home to the first service in the UK to implement DAT outside of a clinical trial setting.
Beyond evidence highlighting the effectiveness of DAT as an addiction treatment, there is a paucity of evidence on broader health outcomes, particularly from a UK perspective. The UK is experiencing its highest rate of drug related deaths in 25 years compounded by an increase of people who use drugs (PWUD) experiencing multi-morbidities, non-communicable diseases, soft skin and tissue infections (SSTI), overdose incidents- all adding to rising hospitalisations. The costs associated with these conditions is significant, and further exacerbated by behavioural factors such as care delay, treatment refusal and discharge against medical advice (DAMA). The most marginalised populations of PWUD are most at risk.
Methods A descriptive analysis of anonymised health records of individuals who had engaged with DAT for 3 (n=15) and 6 (n=12) months was conducted comparing engagement outcomes prior to during their treatment period.
Primary outcome measures were number of incidents of wound care, Soft Skin and Tissue Infections [SSTIs], overdose [OD] situations, unplanned overnight stays in hospital, incidents of treatment refusal and discharge against medical advice (DAMA). Secondary outcome measures were costs associated with these activities (not including treatment costs), calculated using the Greater Manchester Combined Authority (GMCA) cost/benefit analysis model, 2019 v1.4
Results The data indicates a shift in healthcare access from a more reactive to a more preventative model. During DAT individual engaged in more wound care, had less OD incidents requiring hospital care, had less incidents of SSTI, particularly those requiring hospital care, reduced unplanned hospital visits and reduced treatment refusal. This shift translated to a reduction of healthcare costs by 62% within 6 months. Our analysis supports the current evidence base pertaining to the acceptability of co-located primary care and treatment services and highlighting trust as an important facilitator of health care engagement.
Conclusion This small exploratory study confirms that there is potential for harm reduction interventions such as DAT, co-located with primary care services to improve healthcare access for some of the most marginalised populations of PWUD. Broader implications on the policy landscape regarding conceptualisations of cost-effectiveness, prevention and reducing inappropriate hospitalisations due to health inequalities are discussed.
Background Diamorphine Assisted Treatment (DAT) is an alternative treatment modality for people who do not benefit from standard treatment (opioid substitution treatment [OST]). Middlesbrough, a town in the North-East England, was home to the first service in the UK to implement DAT outside of a clinical trial setting.
Beyond evidence highlighting the effectiveness of DAT as an addiction treatment, there is a paucity of evidence on broader health outcomes, particularly from a UK perspective. The UK is experiencing its highest rate of drug related deaths in 25 years compounded by an increase of people who use drugs (PWUD) experiencing multi-morbidities, non-communicable diseases, soft skin and tissue infections (SSTI), overdose incidents- all adding to rising hospitalisations. The costs associated with these conditions is significant, and further exacerbated by behavioural factors such as care delay, treatment refusal and discharge against medical advice (DAMA). The most marginalised populations of PWUD are most at risk.
Methods A descriptive analysis of anonymised health records of individuals who had engaged with DAT for 3 (n=15) and 6 (n=12) months was conducted comparing engagement outcomes prior to during their treatment period.
Primary outcome measures were number of incidents of wound care, Soft Skin and Tissue Infections [SSTIs], overdose [OD] situations, unplanned overnight stays in hospital, incidents of treatment refusal and discharge against medical advice (DAMA). Secondary outcome measures were costs associated with these activities (not including treatment costs), calculated using the Greater Manchester Combined Authority (GMCA) cost/benefit analysis model, 2019 v1.4
Results The data indicates a shift in healthcare access from a more reactive to a more preventative model. During DAT individual engaged in more wound care, had less OD incidents requiring hospital care, had less incidents of SSTI, particularly those requiring hospital care, reduced unplanned hospital visits and reduced treatment refusal. This shift translated to a reduction of healthcare costs by 62% within 6 months. Our analysis supports the current evidence base pertaining to the acceptability of co-located primary care and treatment services and highlighting trust as an important facilitator of health care engagement.
Conclusion This small exploratory study confirms that there is potential for harm reduction interventions such as DAT, co-located with primary care services to improve healthcare access for some of the most marginalised populations of PWUD. Broader implications on the policy landscape regarding conceptualisations of cost-effectiveness, prevention and reducing inappropriate hospitalisations due to health inequalities are discussed.
| Original language | English |
|---|---|
| Article number | A70-A71 |
| Journal | Journal of Epidemiology and Community Health |
| Volume | 77 |
| Issue number | Supp 1 |
| DOIs | |
| Publication status | Published - 6 Sept 2023 |
| Event | Society for Social Medicine & Population Health Annual Scientific Meeting 2023 - Newcastle University, Newcastle upon Tyne, United Kingdom Duration: 6 Sept 2023 → 8 Sept 2023 |