A Social Marketing Approach to the ‘wicked’ problem of alcohol
Newcastle upon TyneNorth TynesideNorthumberland
Lynda SeeryPublic Health Lead for Substance Misuse
Starting point – available datasets
• Hospital Episode Data - detailed• A&E data - limited• Crime data• Service data• Strategic Assessment data• Health Needs Assessment data• Social Care Data
– Incapacity benefits– Housing data– Supported Housing data
Admissions data vs A&E data• There is a need to distinguish between the 2 sets of data – differences
• A&E attendance (i.e. injury, intoxication, physical problem)– Primary diagnosis– Contributory factor i.e. alcohol (coding issues)– Differing requirements of the data – i.e. cross referencing to
crime/violence
• Admitted to hospital – specific vs related alcohol admissions– Primary diagnosis– Conditions which arise or are further identified during hospital spell
(coding)• Mental health & behavioural disorders due to alcohol related
harm• Intoxication• Cirrhosis of the liver• Pancreatic disease
• Can be numerous codes during hospital stay
Analysis of hospital admissions
• complex indicator• requested dataset 1/7/2007 – 30/9/2009• all admissions within ‘specific’ set of codes • Highest number of admissions in these 3
categories– F10 mental & behavioural disorders due to
alcohol– K70 alcoholic liver disease– T51 intoxication
HES Records• postcode level• Specific codes - wholly attributable to
alcohol (main focus)
• 1411 admissions (707) patients• between 141 – 202 admissions each qtr• Costs = £2.5m• 943/1411 readmissions (66.8%)• 239/707 patients readmitted (33.8%)• 153 males & 86 females• 468/707 patients admitted once (66.2%)• age breakdown
NewcastleProportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-5445-54
55-64
55-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Newcastle population Newcastle admissions
North TynesideProportion of population in each age group. North Tyneside population as a whole and North Tyneside admissions
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-5445-54
55-64
55-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
North Tyneside population North Tyneside admissions
NorthumberlandProportion of population in each age group. Northumberland population as a whole and Newcastle admission 1/4/07 - 31/3/09
<15
<15
15-24
15-24
25-34
25-34
35-44
35-44
45-54
45-54
55-6455-64
65-74
65-7475-84
75-8485+ 85+
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Northumberland population Northumberland admissions
Segmentation - understanding the patient layers
The ‘patient layers’ fall into the following categories:
• Patients admitted to hospital for 1 day or less (no overnight stay)
• Patients admitted only once
• Patients admitted once for intoxication / patients re-admitted for intoxication
• Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)
• Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas
• Patients with severe ongoing/end stage illness
Patients admitted once only for 1 day or 8 hours or less
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Newcastle PCT North Tyneside PCT Northumberland CT
Admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(patient admitted once for 1 day or less)
Stomach or Duodenum Disorders
Ingestion Poisoning or Allergies
Epilepsy
Syncope or Collapse
Gastrointestinal Bleed
Sprains, Strains, or Minor Open Wounds
Chronic Pancreatic Disease
Chest Pain
General Abdominal Disorders
Poisoning, Toxic, Environmental
Example of intoxication record
Codes listed
T40 (primary diagnosis)
poisoning by drugs, medicaments and biological substances
X620 intentional self harm
T51 intoxication/toxic effects of substances non medicinal as to source
S099 injuries to head
W19 fall
F101 harmful use
‘Frequent users’ or re-admissions to hospital
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Newcastle PCT North Tyneside PCT Northumberland CT
Re-admissions by top 10 alcohol related conditions - North of Tyne 1/4/07 - 31/3/09(239 frequent users accounting for 943 admissions )
Stomach or Duodenum Disorders
Gastrointestinal Bleed
Chronic Obstructive PulmonaryDisease or Bronchitis
General Abdominal - DiagnosticProcedures
Pancreatic Disorders
Drainage of Ascites
Poisoning, Toxic, Environmental
General Abdominal Disorders
Chronic Liver Disorders
Chronic Pancreatic Disease
Example of re-admission recordCodes listed
K703 (primary diagnosis)
Diseases of the liver
F102 Dependence syndrome
I10X Hypertensive diseases
J459 Chronic lower respiratory diseases
R18X Symptoms and signs involving the digestive system and abdomen
Z720 Persons encountering health services in other circumstances
Z867 Persons with potential health hazards related to family and personal history and certain conditions influencing health status
Target groups• Initial target groups
– patients re-admitted for intoxication
- Patients with multiple re-admissions for alcohol-related harm (harmful and dependent drinkers)
Significant 60
– Patients with chaotic lifestyles accessing hospital services across the 3 PCT/Local Authority areas
North of Tyne 20
Male Female
Newcastle 44 49
North Tyneside 22 22
Northumberland 17 25
Establishment of Community Alcohol Teams
What will Community Alcohol teams provide?
• Service primarily focused on service provision within the community setting, building capacity in tier 2 and enhancing tier 3 provision of specialist services
• Community / home detox support being developed (as appropriate)
• Assessment, expert clinical advice, managing health risk for those individuals with a dominant single condition i.e. alcohol
• Establishment of Community Open Clinics – development of ‘wrap-around’ services (provide monitoring of physical and mental health, alcohol counselling, assessment and advice regarding relapse prevention)
• Partner presence at Community Open Clinics: social care worker, housing advice, benefits advice, assertive outreach to support attendance at clinics.
• Venues will vary across the city - targeted areas across the city
• The establishment of a regular Community Open Clinic at Cyrenians work with vulnerable individuals with alcohol related problems including those experiencing social exclusion
Key areas of development• Multi agency care plans
– (individuals may have a single dominant condition i.e. alcohol but may be known to different agencies)
• Community Open clinics (walk in, self refer, referred into from any other service) – Professionals available at clinics, clinical & mental health staff,
social care, housing, benefits
• Assertive Outreach • Emerging workforce (i.e. new roles, liaison, co-ordination,
systems approach to service delivery)
• A&E – Alcohol Liaison Workers
• Wider use of IBAs (pragmatic approach - multi agency training)
BROADENING THE BASE OF “TREATMENT” FOR ALCOHOL PROBLEMS
• Most important change in treatment of alcohol problems over last 10-20 years: focus of intervention broadened from just “alcoholics” to much larger number of “excessive drinkers” (i.e., hazardous and harmful drinkers).
• Sufficient number of excessive drinkers show progressive deterioration to make early intervention and secondary prevention an essential part of national response to alcohol-related harm. Such an approach is likely to be highly cost-effective.
• For many types of problem, the major contribution to alcohol's costs to society comes from drinkers with less frequent and serious problems, cf. “the preventive paradox”
Community Open Clinics
– Professionals available at clinics, clinical & mental health staff, social care, housing, benefits
• Locations– City/Town centres– Community centres– Universities– ‘Peoples Kitchen’ (Newcastle)– Shopping Centres
2010 2015 2020 2025
A
B
C
Lead time for achieving outcomes & impacting on alcohol target
Gestation from input to outcome
Reducing the harm from alcohol - Alcohol-harm related hospital admission rates (NI 39)
Treatment – Integrated service approach to those individuals admitted to hospital
Treatment – Integrated service approach to those individuals admitted to hospital or those suffering from alcohol misuse
Brief & Extended Interventions
Prevention – education & communication
Heavier enforcement
Sensible drinking campaigns
Social Marketing - initiatives
How long will it take us to impact on our target?
How hard can it be?
•Pace
•Purpose
•Passion
Questions?