Despite a high prevalence of drug and alcohol (AOD)-related morbidity among patients presenting to emergency departments, acute care settings and pre-admission clinics, previous research has found AOD-related morbidity is not commonly identified on admission. AOD-related morbidity has important implications for patient management whilst in hospital as well as on re-admission rates. Consultation Liaison (CL) services are an intervention implemented in clinical settings to provide direct access to specialist services for support, treatment, advice and assistance with the management of a given condition. CL services have been adapted to the AOD field to reduce the health burden and associated costs that AOD problems place on the health system, such as inpatient ward access and exit blockages and re-admissions. NSW Health has provided specific funding to enhance AOD CL services in four Area Health Services: Sydney South West, Hunter New England, Greater Southern and Greater Western.
NDARC, in collaboration with the Centre for Health Economics Research and Evaluation (CHERE), has been contracted by NSW Health, Mental Health and Drug and Alcohol Office (MHDAO), to undertake an evaluation of Drug and Alcohol Consultation Liaison Services (AOD CL) in NSW. This evaluation will also include the development of a clinical model of care for the establishment of future CL services in NSW and to standardise service provision in existing hospitals and Area Health Service.
To determine whether the implementation of clinical liaison services for drug and alcohol (AOD CL) increases the identification of patients with drug and alcohol problems and improves the health outcomes and treatment pathways for patients with drug and alcohol problems.
The evaluation comprises three sub-studies:
- Patient Survey: This survey will be undertaken in the Emergency Department and additional select wards (e.g. orthopaedic, psychiatry) in eight NSW hospitals to identify the contribution of substance use to patient’s current presentation and the proportion of patients presenting with a recent history of substance use requiring an intervention. Data collection will occur 24hrs for a period of 10 days. The Patient Survey is designed to be self-completed. A sub-sample of patients identified as having a substance use problem will be followed up at three months to examine their use of health services and uptake of referrals to drug treatment if attended to by AOD CL staff. This component is being undertaken by NDARC.
- Cost Effectiveness Analysis: The cost effectiveness of AOD CL services will be ascertained using data linkage of the baseline patient survey, emergency department presentations, hospital separations, use of AOD CL services and MBS/PBS data. Participants will be tracked for a 36-month period (18 months either side of their baseline survey date). This component is being undertaken by CHERE.
- Model of Care / Clinical Pathways: In-depth interviews with AOD CL and general hospital staff will be undertaken to document the model of CL implemented at each site and the impact of AOD CL services on patient management and clinical pathways. Fourteen hospitals are participating in this component. This component is being undertaken by NDARC.
The final report is currently with NSW Health, Mental Health and Drug and Alcohol Office awaiting release.
The Model of Care draft document was submitted to NSW Health, Mental Health and Drug and Alcohol Office in May 2012. The final report was submitted to NSW Health, Mental Health and Drug and Alcohol Office in October 2014.
Late breaking paper session at APSAD 2014.