23/11/2015. Introduction & Aims. Methods. Methods. Survey response. Patient Survey (baseline)

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1 Intrductin & Aims Drug and Alchl Cnsultatin Liaisn (AOD CL) services aim t imprve identificatin and treatment f patients with AOD mrbidity. The csts and cnsequences f targeting AOD patients presenting t hspital emergency departments Butler K, Reeve R, Arra S, Gdall S, Van Gl, K & Burns L. Our Aims 1. T investigate the prevalence f AOD related hspital presentatins 2. T cnduct an ecnmic evaluatin t investigate the cst and cnsequences f prviding AOD CL services 2 Methds Baseline and fllw-up patient surveys Patients recruited frm ED and selected wards at 8 NSW public hspitals Baseline surveys administered in each hspital ver 10 days, where all waiting patients were apprached and screened fr eligibility. Fllw-up survey was administered t thse wh screened psitive fr having substance use prblems, and wh cnsented t be fllwed up. Methds Ecnmic evaluatin Linked data analysis survey participants wh cnsent t data linkage Medical recrd data (CL, ED, AP, MBS and PBS) 18 mnths prir t 12 mnths pst survey Analysis f health system resurce use and csts ver time. Cmparisns f patients with and withut AOD prblems, and patients with AOD prblems wh receive and d nt receive CL services. Cst-cnsequences analysis Estimated impacts f CL cmpared with the cst f prviding CL services. 3 4 Patient Survey (baseline) Survey respnse Measures include: reasn fr presentatin cntributin f substance use t current presentatin, substance use in past 24 hurs, recent prblematic substance use 3,043 were eligible 1,859 cnsented 1,615 cmpleted general functining 4,132 apprached use f drug and alchl services 5 6 1

2 Demgraphics Recent use Male 53% Any substance 35 Female 47% Alchl 27 Mean Age 41 years ld (16-98) Sedatives 5 Opiids 4 ATSI 5% Cannabis Cntributin t presentatin Any substance 30 Alchl 19 Cannabis 4 Sedatives 3 ATS 2 AOD Grup The Alchl, Smking and Substances Invlvement Screening Test (ASSIST) Tbacc Alchl Cannabis Ccaine Amphetamine-type stimulants Sedatives Hallucingens Inhalants Opiids Opiids AOD Grup demgraphics AOD GROUP (n=553) NON-AOD GROUP Male 62% 48% Mean age Range 37 years years ATSI 6% 4% WHO-DAS Median scre 16* 13 Patient FOLLOW UP Survey Measures include: Change in substance use General functining Health and service utilisatin Client perspectives n the impact f CL interventin n their substance use Uptake f referrals t drug and alchl treatment

3 Changes in substance use Disability Disability scres marginally in thse wh n lnger met criteria fr substance use prblems. Thse wh n lnger met criteria fr substance use prblems were fund t have had better disability scres at baseline Referrals Service utilisatin Patients were asked... If they had recently accessed any services (since baseline) Been referred by a hspital staff member during the presentatin captured at baseline Linked data analysis Ecnmic evaluatin Baseline survey data fr cnsenting patients linked t CL, ED, APDC, PBS and MBS data Analysis f each dataset cnducted in 3 parts: 1.Whether utcmes differ fr patients wh have an underlying AOD prblem cmpared t thse wh dn t the case fr interventin; 2.Whether utcmes fr patients with AOD prblems differ between thse wh receive CL services and thse wh dn t t identify the apprpriate cmparisn grup; 3.Regressin mdels t estimate trends ver time and changes pre- and pst 1 st bserved cntact with CL relative t changes fr the cmparisn grup the impact f CL

4 Sample and CL data extractin Hspital Patients surveyed Identified with AOD prblems Survey participants with data linkage Patients in the linked sample with AOD prblems Patients in the linked sample with CL data* N/A Ttals Chsing the cmparisn grup Descriptive cmparisns f baseline and ED data shwed that patients referred t CL during the bservatin perid are similar t thse screened as requiring an intensive interventin but wh were nt seen by CL. Bth grups mre likely t depart withut waiting and present mre frequently, and had similar substance use patterns than peple wh screened as requiring nly a brief interventin. Suggests that the intensive need (n CL) grup are an apprpriate cmparisn grup fr the evaluatin. At least ne CL referral in the 2.5 year extractin perid (18 mnths pre- t 12 mnths pst-survey) Estimating changes ver time (pre and pst interventin) Interrupted time series mdels t estimate differences between thse wh saw CL and the cmparisn grup befre and after the interventin Difference in difference apprach, t cntrl fr baseline differences. Cntrls fr survey perid, t avid selectin bias Cntrls fr patient differences (age, gender, Indigenus status, sciecnmic status) Cntrls fr the hspital Analysis f ED presentatins and csts, inpatient admissins and csts, PBS and MBS utilisatin and csts Regressin analysis: key findings Relative t the cmparisn grup and cntrlling fr ther factrs (including baseline differences), after the interventin peple seen by AOD CL services have: Reduced average length f stay in ED ver time Imprved emergency admissin perfrmance Reduced rate f presentatins ver time Reduced cst f ED presentatins ver time, with predicted savings f $ per persn in the year fllwing 1 st CL visit decreases the rate f inpatient admissins ver time (althugh n significant difference in change in cst f admissins) increases the uptake f selected PBS drugs and assciated csts but with n verall increase in PBS csts Cst-cnsequences analysis: Cst Data prvided by Directrs f AOD services n CL csts per annum and number f new patients per annum used t derive average cst per patient Hspital * Average annual cst f prviding CL $ Staff Cnsumables Ttal Number f new patients per annum Average cst per new patient $ 1 340,000 10, , ,000 20, , ,828 4, , ,592 14, , , , Cst-cnsequences analysis: Cst-benefit The average cst f prviding CL per new client is estimated at $657. Average number f new clients per site per annum is 512. Frm the regressin results, predicted ED cst savings f $860 per new CL client in the year fllwing their first cntact with CL Based n this estimate CL is expected t result in net savings t NSW Health f $203 ($860 - $657) per new CL client in the first year pst CL. On average this amunts t an estimated net benefit f $103,936 per annum per site ($203x 512 new clients per site). Overall average

5 Cst-cnsequences analysis In additin t an estimated net benefit f $103,936 per annum per site, evidence frm regressin analysis that CL: prevents an increase in average LOS in ED ver time prevents a wrsening in emergency admissin perfrmance decreases frequency f presentatins ver time decreases the rate f admissins ver time increases the uptake f selected PBS drugs and assciated csts but with n verall increase in PBS csts As CL services currently nly see ¼ f patients requiring intensive interventin, expanding these services may lead t even greater cst savings. Thank yu Kerryn.butler@unsw.edu.au