Abstract
Introduction:Frequent attenders to Emergency Departments (ED) often have contributing substance use disorders (SUD), but there are few evaluations of relevant interventions. We examine one such pilot assertive management service set in Sydney, Australia (IMPACT), aimed at reducing hospital presentations and costs, and improving client outcomes.Methods:IMPACT eligibility criteria included moderate-to-severe SUD and ED attendance on ≥5 occasions in the previous year. A pre-post intervention design examined clients’ presentations and outcomes 6 months before and after participation to a comparison group of eligible clients who did not engage.Results:Between 2014 and 2015, 34 clients engaged in IMPACT, with 12 in the comparison group. Clients demonstrated significant reductions in preventable (p < 0.05) and non-preventable (p < 0.01) ED presentations and costs, and in hospital admissions and costs (p < 0.01). IMPACT clients also reported a significant reduction in use days for primary substance (p < 0.01). The comparison group had a significant reduction (p < 0.05) in non-preventable visits only.Conclusions:Assertive management services can be effective in preventing hospital presentations and costs for frequent ED attenders with SUDs and improving client outcomes, representing an effective integrated health approach. The IMPACT service has since been refined and integrated into routine care across a number of hospitals in Sydney, Australia.
Highlights
Frequent attenders to Emergency Departments (ED) often have contributing substance use disorders (SUD), but there are few evaluations of relevant interventions
Data from two groups of clients are included in the evaluation: those assessed as eligible who participated in the IMPACT service, and a comparison group of clients assessed as eligible but who did not engage in the IMPACT service beyond their initial assessment
We report on the first evaluation of an assertive management approach for frequent ED attenders with moderate to severe SUDs in an urban Australian setting
Summary
Frequent attenders to Emergency Departments (ED) often have contributing substance use disorders (SUD), but there are few evaluations of relevant interventions. We examine one such pilot assertive management service set in Sydney, Australia (IMPACT), aimed at reducing hospital presentations and costs, and improving client outcomes. In Australia, frequent ED users (from here defined as 5 or more ED presentations per year in line with other Australian studies [8,9,10]) were more likely to be admitted to hospital, more likely to have a psychiatric (including substance use) diagnosis and more likely to self-discharge while waiting for care than non-frequent users [8].
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