Controlled observational study and economic evaluation of the effect of city-centre night-time alcohol intoxication management services on the emergency care system compared with usual care.

BACKGROUND: Alcohol intoxication management services (AIMS) provide an alternative care pathway for alcohol-intoxicated adults otherwise requiring emergency department (ED) services and at times of high incidence. We estimate the effectiveness and cost-effectiveness of AIMS on ED attendance rates with ED and ambulance service performance indicators as secondary outcomes. METHODS: A controlled longitudinal retrospective observational study in English and Welsh towns, six with AIMS and six without. Control and intervention cities were matched by sociodemographic characteristics. The primary outcome was ED attendance rate per night, secondary analyses explored hospital admission rates and ambulance response times. Interrupted time series analyses compared control and matched intervention sites pre-AIMS and post-AIMS. Cost-effectiveness analyses compared the component costs of AIMS to usual care before with results presented from the National Health Service and social care prospective. The number of diversions away from ED required for a service to be cost neutral was determined. RESULTS: Analyses found considerable variation across sites, only one service was associated with a significant reduction in ED attendances (-4.89, p<0.01). The services offered by AIMS varied. On average AIMS had 7.57 (mean minimum=1.33, SD=1.37 to mean maximum=24.66, SD=12.58) in attendance per session, below the 11.02 diversions away from ED at which services would be expected to be cost neutral. CONCLUSIONS: AIMSs have variable effects on the emergency care system, reflecting variable structures and processes, but may be associated with modest reductions in the burden on ED and ambulance services. The more expensive model, supported by the ED, was the only configuration likely to divert patients away from ED. AIMS should be regarded as fledgling services that require further work to realise benefit. TRIAL REGISTRATION NUMBER: ISRCTN63096364.

The acceptability of alcohol intoxication management services to users: A mixed methods study.

INTRODUCTION AND AIMS: Alcohol Intoxication Management Services (AIMS) provide basic care for intoxication and minor injuries, have been increasingly implemented in urban areas characterised by a large number of premises licensed for the sale and on-site consumption of alcohol, with the goal of reducing alcohol's burden on emergency services, including referrals into hospital emergency departments. The acceptability of new health services to users is a key effectiveness outcome. The aim was to describe patient experiences when attending an AIMS and document the acceptability of AIMS to users. DESIGN AND METHODS: A sequential mixed methods study was undertaken involving semi-structured interviews with participants from four AIMS followed by a survey of users recruited from six AIMS. RESULTS: Interviewees (N = 19) were positive about the care they received in AIMS and appreciated the friendly, non-judgemental atmosphere. Survey respondents rated their experience in AIMS positively (on a 0 to 10 Likert scale, mean = 9.34, SD = 1.38, n = 188). Frequently given reasons for attendance included drinking alcohol (57%) and minor injury (42%); 24% said they would have attended the emergency department had the AIMS not been available and 6% said they would have preferred to go to the emergency department; 31% indicated they would have felt unsafe without the AIMS. DISCUSSION AND CONCLUSIONS: AIMS are acceptable to users. AIMS are likely to address previously unmet demand for a safe space within the night-time environment.