జర్నల్ ఆఫ్ అడిక్షన్ రీసెర్చ్ & థెరపీ

నైరూప్య

A New Paradigm in Management of Frequent Attenders to Emergency Departments with Severe Alcohol Use Disorder ? A Pilot Study for Assertive Community Treatment in Singapore

Mak CCM, Mao DRH, Siddiqui FJ, Lim A, Bachik R, Ng CWL, Davamoni-Thomas J, Tang JP, Kandasami G, Lee C

Introduction: A majority of frequent users of emergency medical services in Singapore present with alcoholrelated problems. These patients are known as Alcohol-Related Frequent Attenders (ARFAs). ARFAs engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction.

Methods: We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed.

Results: All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention six-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention six-month period (Z=-2.244, p=0.025). CISS scores showed significant improvement pre-intervention period median of 13.5 (range 9-16) or high problem severity vs post-intervention 6.5 (range 1-10, p=0.001) or average problem severity.

Conclusion: This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in ARFAs. A multi-center, prospective study using ACT for ARFAs across four hospitals in Singapore is currently underway.