The Relay Study – recruiting patients to treatmentWe need better strategies to ensure that alcohol-dependent patients receive the necessary treatment for their condition. It is striking that although approximately 140,000 people in Denmark suffer from alcohol dependence; only 7-10,000 are treated for alcohol use disorders in the public treatment institutions each year. The reluctance to seek treatment may be due to low motivation to change behaviour, practical problems, and fear of being stigmatized or ignorance about access to treatment, but is also due to missed opportunities in the health care system for referring patients to further treatment. Greater use of specialized treatment for alcohol dependence is a key element in society’s response to alcohol problems and its consequences. General hospitals are an obvious place to identify individuals with treatment for alcohol use disorder as the prevalence of alcohol use disorder is high in inpatients. Departments of gastroenterology, neurology and orthopaedic surgery have the highest prevalence (Babor et al., 2001). Moreover, only around 50% patients referred for specialized treatment actually commence therapy.
RESCueH Alcohol Research Programme Proposal to the Lundbeck Foundation
Patient contracts and reinforcement strategies are some of the more promising low-cost interventions for increasing participation in outpatient treatment. Only few studies have assessed these strategies, however. The Relay Study will test a new model for referring patients. It is a multi-centre study involving hospitals in both urban and rural areas and will be conducted in hospital departments that have a high number of patients with alcohol-related diseases.
Purpose of the studyWe hypothesize that the Relay Model is more effective and less costly than standard methods with regards to referral of alcohol-dependent patients from hospital to specialized treatment.
DesignIn a randomized controlled design, the Relay Model will be compared with Referral as Usual over a follow-up period of one year. A total of 1,000 consecutive patients admitted to the departments of gastroenterology, neurology and orthopaedic Surgery at Odense University Hospital (urban area) and Aabenraa Hospital, Sygehus Sønderjylland (rural area), who screen positive for alcohol dependency using the Alcohol Use Identification Test (Audit) will be enrolled in the study. The primary outcome comprises the health care costs and social welfare costs in the year following the intervention. The secondary outcome is the number of patients beginning specialized treatment for alcohol use disorder after discharge from the general hospital. Data will be collected from registers and databases and merged using the Danish Civil Registration System.
InterventionsThe Relay Model: In the experimental intervention, a therapist from the alcohol treatment clinic meets the patient before discharge, explains the significance of continuing outpatient aftercare and presents an "attendance contract". This contract includes information about prognosis for alcohol disorders and options for attending outpatient care. The patient is given an appointment at the alcohol treatment clinic and is recommended to place the contract in a prominent place at home.
Referral as Usual: In the standard intervention, the patient is encouraged to seek treatment for alcohol use disorder after discharge. The hospital personnel email the alcohol treatment clinic, and the patient is given an appointment and a meeting card.
We expect health care costs during the 12 months after hospital discharge to be significantly lower in the experimental group than in the standard referral group. We also expect that the number of patients initiating treatment at the specialized treatment clinic within two weeks after discharge will be higher in the experimental Relay Model than in the control group.
If the new referral approach is found to be successful, it is likely that the intervention could be implemented more widely. If the Relay Model is found to effective in a somatic hospital setting, it could, for example, be evaluated in a general practice setting.
Professor Bent Nielsen, UCAR.