1. ‘ R e v o l v i n g d o o r
p a t i e n t s ’ — t h e
a f t e r c a r e a n d
monitoring of patients
with alcohol dependence
syndrome in a primary
care setting in Salford

2. 1,059,210 admissions
(2013-14)

3. Poisoning
Mental and behavioral disorders
Alcoholic polyneuropathy
Alcoholic myopathy
Alcoholic liver disease
Gastritis
Cardiomyopathy
Acute and chronic pancreatitis
Accidents, injury
Chronic liver disease
Diabetes mellitus
Epilepsy and status epilepticus
Falls
Peptic ulceration
Oesophageals varices
Heart faiure
F u l l y
attributable
P a r t i a l l y
attributable

4. Alcohol Dependence Syndrome (ICD-10)
> 3 of the following criteria:
✤ Strong desire or sense of compulsion to take the substance;
✤ Difficulties in controlling substance-taking behaviours;
✤ Physiological withdrawal state when substance use has ceased or
has been reduced, or taking the substance with the intention of
relieving or avoiding withdrawal symptoms;
✤ Evidence of tolerance;
✤ Progressive neglect of alternative pleasures or interests;
✤ Persisting with substance use despite clear evidence of overly
harmful consequences.

5. > 15 units / day
Treatment Goal: Abstinence
Prevalence — 5.9%

7. 94 patients
Alcohol dependence syndrome
Female
33,33 %
Male
66,67 %

8. Unemployment — of working age,
87% affected by alcohol

9. Psychiatric co-morbidity
63% of all patients
78% of whom, depressed
43%, anxious

10. 50% of all patients
attended A&E for alcohol-related
reasons
74%

11. Alcohol Use Disorders Identification Test
(AUDIT)
Comprehensive screening tool (1995, WHO)
✤ Frequency
✤ Impaired control
✤ Morning drinking
✤ Injury
✤ Blackouts
✤ Guilt
8.5% — AUDIT > 20, documented at
least once
5% — AUDIT 16-20, documented at
least once

12. 99% — units consumed were recorded
as well as other metrics, e.g. ‘Ex-drinker’,
‘Light drinker’, ‘Moderate drinker’, ‘Harmful
drinker’

13. 79% offered ‘structured brief
intervention’ (i.e. health
education)

14. 8 1 % h a d h a d r o u t i n e
biochemical tests
Useful for screening for:
Macrocytic anaemia
Deranged LFTs
↑ GGT

15. PRECARE
16%
Self-help groups
51%
T h i a m i n e
(Vitamin B1)
52%
Psychological input
e.g. primary care mental health,
psychiatric referral

16. Documented referrals to

17. % of all patients who accessed
at least once

18. AFTERCARE
80%
Psychological input
for those with pre-existing co-
morbid psychiatric disorders
100% prescriptions
maintained by G.P.
Acamprosate
( c a m p r a l ) ,
d i s u l f i r a m
( A n t a b u s e ) ,
thiamine

19. 83% of all patients who received a medically
assisted withdrawal, or other support, from
CAT, relapsed.
This was revealed through A&E attendances
for alcohol-related reasons in 41% of these
patients.

20. Final review of records — at the end of the
audit:
40 out of the 94 patients had
achieved abstinence or self-
moderation when last screened

21. ✤ Systematically screen all patients using the AUDIT
✤ Use abbreviated AUDIT tools (FAST, AUDIT-C), in consultations,
where relevant
✤ Signpost patients to assisted withdrawal services and open-access
group therapies
✤ Continue following up prescriptions of relapse prevention
medications initiated by CAT
✤ Ensure all these are reviewed on 6-monthly basis by biochemical
assessment
✤ Continue to refer those with persistent psychological symptoms
for psychological and psychiatric support
✤ Follow up patients after assisted withdrawal using low-intensity
measures (e.g. telephone calls), for at least 3 years afterwards