Abstract
BackgroundThe increasing mortality rates from alcohol-related liver disease (ARLD) are a public health concern. To address this, alcohol care teams (ACT) case-find and lead management of alcohol issues for these patients. Local assessments of ACTs have shown reductions in emergency admissions and emergency department attendances. We examine the impact of ACTs on emergency hospital activity following a diagnosis of ARLD.MethodsAdministrative Hospital Episode Statistics (HES) data were extracted. Information on ACT provision at English NHS hospital trusts and sites in 2009/10 was taken from a survey by Public Health England. We undertook a difference-in-difference analysis to compare emergency hospital activity for a cohort of individuals diagnosed with ARLD who presented to hospitals either with or without an ACT in the one year before and after a first ARLD diagnosis during 2009/10.ResultsOver the study period, 9,165 individuals eligible for inclusion in our study had a first diagnosis of ARLD. 4,768 presented to one of 41 hospital trusts with an ACT (59 sites) and 4,397 presented to one of 50 non-ACT hospital trusts (65 sites). Whilst age and sex demographics were similar between the two cohorts, the ACT hospital cohort had a higher proportion of individuals in the most deprived quintile (41.6 % v 28.5 % p < .0001). In the difference-in-difference analysis, the presence of an ACT at a hospital trust was not associated with a change in all-cause emergency admissions (0.020 (95 % CI −0.070, 0.111), p = 0.656), alcohol-related emergency admissions (−0.025 (95 % CI −0.104, 0.054), p = 0.536) or all-cause emergency department attendances (0.042 (95 % CI −0.087, 0.171), p = 0.521). Sensitivity analyses by sex and hospital site did not affect the study findings.ConclusionsIn this study, the presence of an ACT at the NHS hospital trust where individuals have their first recorded diagnosis of ARLD does not appear to be associated with subsequent emergency hospital activity within these populations. Further analysis focussing on the components and specific effects of ACT interventions on individuals and systems both pre- and post-diagnosis of ARLD may reveal important avenues to improve care.
Highlights
The increasing mortality rates from alcohol-related liver disease (ARLD) are a public health concern
A case-control study from the UK demonstrates that patients with alcoholic liver cirrhosis have an increased rate of alcohol-related admissions in the year prior to diagnosis compared to the general population and there is an opportunity for preventative interventions in secondary care [6, 7]
We proposed that presence of alcohol care teams (ACT) at hospitals where a first recorded diagnosis of ARLD was made would be associated with a reduction in emergency hospital activity when examining the difference in activity before and after this point in comparison to where there were no ACTs as a result of dedicated support to help these patients
Summary
The increasing mortality rates from alcohol-related liver disease (ARLD) are a public health concern. In England and Wales 600,000 people have some form of liver disease of whom 60,000 people have cirrhosis, leading to 57,682 hospital admissions and 10,948 deaths in 2012 [3]. Three-quarters of liver disease mortality is secondary to excess alcohol use [4] and rates of alcohol consumption remain a concern [1]. A case-control study from the UK demonstrates that patients with alcoholic liver cirrhosis have an increased rate of alcohol-related admissions in the year prior to diagnosis compared to the general population and there is an opportunity for preventative interventions in secondary care [6, 7]
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