Frequent attenders to A&E departments: A qualitative study of

people who repeatedly present with alcohol-related health

conditions
Tom Parkman, Jo Neale, Colin Drummond, Ed Day

Definition
any patient aged 16 or over who attends any
A&E department 10 or more times within a year
or 5 or more times within a 3-month period for an
alcohol related condition (ISD Scotland, 2011)

Aims and objectives

v

Overarching aim:

To provide detailed insights into the characteristics, views and experiences of individuals who
repeatedly present to A&E with alcohol-related health conditions in order to optimise the
development, implementation and evaluation of interventions for them
v

Objectives
1.
2.
3.
4.
5.
6.
7.

Understand demographics and social circumstances

Drinking/drug patterns
Exposure and attitude to services
Views on assertive outreach
Reasons for A&E attendance
Their desired support needs
Potential feasibility of future clinical trials with AFAs and engaging them in treatment

2 stages

Stage 1
v Participants:
v 4

30 AFAs

Hospitals:

v
v
v
v

Guys and St Thomas

Kings College Hospital
St Georges
Croydon University Hospital

v Qualitative
v
v

data

Single, Semi-structured interviews will aim to (partially) inform stage 2

Iterative approach

v Quantitative
v

data

Severity of Alcohol dependence (SADQ), Alcohol Problems Questionnaire

(APQ), Health status (EQ-5D)

Research to date: Stage 1

v

Interviewed 13 AFAs in the community

v
v
v
v
v

Housing status
v
v
v
v
v

2 homeless
1 in YMCA
1 in a wet hostel
1 living with his mum
8 living in council housing

Employment status
v

9 males
4 females
Age range: 25 63 years
12 heavily drinking, 1 in recovery (3 months)
1 has used drugs in the past but never became dependent

All unemployed

Income
v

10 on jobseekers allowance, 2 on Employment and Support allowance (disability benefits), 1 has no

income (living here illegally).

Stage 1: initial findings

v

Not based on any in depth analysis BUT some key themes:

All have mental health problems

Many years of heavy, sustained drinking
Most not accessing any service at all.
All have physical problems = mobility issues to access services
Socially isolated
Acutely aware of their own problems but have NO knowledge of services at all (except
A&E). Support for assertive outreach.
Frustration at the services they have encountered (GPs, self-help)
Laconic and great difficulty articulating their problems
Inaccuracies when reporting is what they are saying a version of the truth?
Very engrained cycle: drink attend A&E discharge drink
Many have positive views about hospital staff (no signs of stigma) BUT several mentioned
that they were discharged very early in the morning and had to get themselves home
Received very little/no advice on drinking when in hospital
Hospital treat physical problems and never address drinking
A&E attendance always precipitated by physical pain. Most call an ambulance.

Research to date: Stage 2

v Single,

focus groups with staff and clinicians

v Between 6-10 in each FG
v 6 chosen hospitals from anywhere in the UK
v Stage 2 hospitals:
v Dorset

County Hospital (no specialist team)

v Hull Royal Infirmary (no specialist team)
v University Hospital Birmingham (no specialist team)
v Bolton NHS Foundation Trust (specialist team)
v Wansbeck General Hospital (specialist team)
v Leeds Teaching Hospital (specialist team)

Thank you for listening!

Questions?