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Wu J, Siddiqui FJ, Mak CCM, Chua ISY, Thangayah JR, Tan EXX, Seet HY, Rao AK, Tan HY, Mohamed A, Hartman M, Leong BSH, Ong MEH, Mao DR. Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol. BMC Health Serv Res 2024; 24:256. [PMID: 38419049 PMCID: PMC10900701 DOI: 10.1186/s12913-023-10516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy-in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions. METHODS Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores. DISCUSSION Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT's efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model's prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations. TRIAL REGISTRATION ClinicalTrials.gov, NCT04447079. Initiated on 25 June 2020.
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Affiliation(s)
- Juntian Wu
- Health Services Research Centre, SingHealth, Outram, Singapore.
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore.
| | - Fahad Javaid Siddiqui
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Outram, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Buangkok, Singapore
| | - Ivan Si Yong Chua
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
| | | | - Esther Xi Xiang Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Jurong East, Singapore, Singapore
| | - Huey Ying Seet
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Adriel Kailing Rao
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Hann Yee Tan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Asif Mohamed
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Novena, Singapore
| | - Mikael Hartman
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Department of Surgery, National University Hospital, Kent Ridge, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Kent Ridge, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
- Unit for Pre-hospital Emergency Care, Ministry of Health, Outram, Singapore
| | - Desmond Renhao Mao
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
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