Mak Charles Chia Meng, Mao Desmond Ren Hao, Siddiqui Fahad Javaid, Lim Alex, Davamoni-Thomas Jayson, Tang June Peiwen, Bachik Rozinah, Ng Charis Wei Ling, Kandasami Gomathinayagam, Lee Cheng
National Addictions Management Service, Institute of Mental Health, Singapore, Singapore.
Acute & Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore.
Front Health Serv. 2022 Nov 4;2:1029455. doi: 10.3389/frhs.2022.1029455. eCollection 2022.
A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to 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.
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.
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 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period ( = -2.244, = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, = 0.001), corresponding to reduction in alcohol-related problem severity.
This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.
新加坡大多数频繁使用紧急医疗服务的人都存在与酒精相关的问题。已知这些患者与传统成瘾服务的参与度较低，而是经常前往急诊科（ED），导致医疗负担沉重。积极社区治疗（ACT）是传统成瘾管理的一种替代干预措施。ACT包括社区探访，重点是整体护理和减少伤害。
我们在新加坡主要的成瘾疾病三级中心进行了一项前瞻性前后队列研究。主要目的是评估ACT在减少全国范围内急诊科与酒精相关就诊人数方面的有效性。收集了2018年4月至2019年3月招募患者的社会人口统计学信息、与酒精相关的急诊科就诊人数以及物质滥用服务基督量表（CISS）得分。进行了描述性分析和Wilcoxon符号秩检验。
所有14名患者均为男性，平均年龄55岁。与酒精相关的急诊科平均就诊次数从干预前6个月的6.8次（范围3 - 22次，中位数5.5次）显著减少45.3%，降至干预后6个月的3.7次（范围0 - 28次，中位数1.5次）（Z = -2.244，P = 0.025）。CISS得分从干预前的中位数13.5（范围9 - 16）显著改善至干预后的中位数6.5（范围1 - 10，P = 0.001），这与酒精相关问题严重程度的降低相对应。
这项试点研究表明，ACT可以有效减少频繁前往急诊科的酒精使用障碍（AUD）患者与酒精相关的急诊科就诊次数以及酒精相关问题的严重程度。目前正在新加坡四家医院针对此类患者开展一项使用ACT的多中心前瞻性研究。
