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STUDY 2010 HTM file
Planned and unplanned discharge from alcohol services in Scotland, 2004–2008
In the mid-2000s over 50% of terminated alcohol treatment episodes in Scotland ended with the client or patient dropping out. Considerable variation between regions suggests there is room for improvement and with it improvement in the cost effectiveness of services.
Seven years after the first alcohol harm reduction strategy for England, this audit finds treatment access and brief intervention work has progressed in London but funding is often precarious and GP services are surprisingly under-developed.
STUDY 2011 HTM file
South East Alcohol Innovation Programme: evaluation report
In the south east of England a bidding exercise spawned a spate of short-term innovative projects to reduce alcohol-related harm, from which five models were assessed as most promising and taken forward for further implementation and assessment the following year – a rapid and intensive test bed from which others can learn as well.
In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes.
In 2007–08 the US state of Maine introduced a new scheme directly linking funding for outpatient treatment services to performance in terms of waiting times and retention, but financial and service delivery impacts were negligible. Were the incentives too weak, or were services already doing as well as they could?
This small English study poses fundamental questions about alcohol treatment services: whether private services suffer from an ‘empathy gap’ and NHS services from poor systems; whether opening up treatment choice to patients with a record of bad decision-making is a good thing; and whether there can be universal criteria for what counts as quality provision.
DOCUMENT 2014 HTM file
How many drinkers should be in treatment?
Depending on the criteria, Britain’s performance in ensuring needy drinkers enter treatment can look anywhere from an abysmal 7% to an excellent 40%. Does where you draw the line depend on how you want to portray Britain’s performance?
Evidence that in 2012 Scotland’s alcohol treatment caseload equated to about 1 in 4 of the country’s alcohol-dependent adults, over three times the 1 in 14 ratio in England, partly a consequence of extra funding accompanying Scotland’s 2009 national alcohol strategy. Evidence too of a peer-based recovery orientation taking root.
A flagship drug treatment policy initiative appears to have backfired in England, where the government’s pilot payment-by-results schemes seem to have led to fewer successful completions of treatment and more prospective patients declining treatment.
MATRIX CELL 2020 HTM file
Alcohol Treatment Matrix cell E2: Treatment systems; Generic and cross-cutting issues
Seminal and key studies on local, regional and national systems for effectively and cost-effectively providing treatment. Explores whether payment by results stifles patient-centred practice or stretches services beyond comfort zones, the surprising results of a randomised trial of service-improvement mechanisms, and the multiple answers to how many drinkers should be in treatment. See the remaining four cells in row 2 of the matrix for more on generic features of medical and psychosocial therapies.
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