None listed
Conditions
Brief summary
Inpatient withdrawal management provides highly supportive care to allow people to safely and successfully complete their withdrawal episode. This duration of hospitalisation is of significant burden, both at the individual level and health system level. Expert consensus from the Clinical Directors of the five Local Health Districtss involved in this project have identified a potential solution – providing the option of a step-down model of care for patients admitted to hospital for alcohol and/or drug withdrawal. Based on clinical risk assessment, this would allow for patients to complete withdrawal in the community, reducing burden on hospital beds and allowing people to receive care from their own homes with access to personal supports. This project seeks to evaluate the impact of this change on length of stay and clinical outcomes using a stepped-wedge trial design where hospitals will randomly begin offering step-down care as an option to their patients over a 54 week period.
Interventions
Step-down care for alcohol and other drug withdrawal: Patients who receive the step-down service will be assessed daily for suitability for discharge from hospital for community-based withdrawal completion by an addiction medicine specialist or psychiatrist, expected to be 1-3 days post admission, and transferred to non-inpatient care for the remainder of their withdrawal management by the service’s existing community health team. This team will manage the participant’s withdrawal until the comp
Step-down care for alcohol and other drug withdrawal: Patients who receive the step-down service will be assessed daily for suitability for discharge from hospital for community-based withdrawal completion by an addiction medicine specialist or psychiatrist, expected to be 1-3 days post admission, and transferred to non-inpatient care for the remainder of their withdrawal management by the service’s existing community health team. This team will manage the participant’s withdrawal until the completion of the withdrawal episode. Community-based treatment will be delivered by each site as clinically indicated based on local needs and service avaliability, and may include face to face or telehealth interventions. Care will be delivered by the site's multidisciplinary Drug and Alcohol teams, comprising of doctors, nurses, allied health professionals, and where available Aboriginal Health and Peer workers. Withdrawal episodes are typically 5-7 days in duration, and will be delivered by specialist drug and alcohol services within NSW. Adherence will be monitored in terms of retention in care by review of medical records for each participant daily.
Sponsors
St Vincent's Hospital Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Participants will be eligible to participate in this study if they: • have been admitted to a participating withdrawal management unit, • are 18 years of age or over, • are willing to be followed up post withdrawal episode, and • are willing to provide written informed consent.
Exclusion criteria
Participants will be excluded if they: • Do not meet the Eligibility criteria for consideration of step-down from inpatient to non-inpatient withdrawal management in public withdrawal management units in NSW • Primary substance of concern for withdrawal is a benzodiazepine
Outcome results
None listed