Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol

Area of Science:

• Public Health
• Addiction Medicine
• Healthcare Management

Background:

• Growing challenge of Alcohol-Related Frequent Attenders (ARFAs) in Singaporean Emergency Departments (EDs).
• Limited engagement of ARFAs with traditional addiction treatment services.
• Need for innovative, community-centered strategies to address ARFA needs.

Purpose of the Study:

• To explore the benefits of Assertive Community Treatment (ACT) for ARFAs in Singapore.
• To assess ACT's impact on reducing ED visits and Emergency Medical Services (EMS) calls.
• To evaluate ACT's effect on improving health outcomes for ARFAs.

Main Methods:

• Prospective before-and-after cohort study design.
• Inclusion of ARFAs (≥21 years, English/Mandarin speaking, ≥5 ED visits/year, ≥2 alcohol-related).
• Comparison of health outcomes between ACT participants and standard care.
• Data collection included socio-demographics, ED/EMS frequency, CISS, UCLA Loneliness, and CESD-R-10 scores over six months.

Main Results:

• The study is designed to contrast health outcomes between patients receiving ACT and those receiving standard emergency care.
• Evaluation metrics include frequency of ED and EMS engagement, alongside validated health assessment tools.

Conclusions:

• ACT offers a patient-centered approach to address the complex needs of ARFAs in Singapore.
• While challenges like attrition exist, ACT has substantial potential to enhance patient well-being and healthcare efficiency.
• Findings may inform future healthcare strategies and policy recommendations for managing alcohol misuse.