Programme of Research for Alcohol Care Teams: Impact, Value and Effectiveness (ProACTIVE)

Alcohol-related hospital admissions continue to rise, with estimates that 10% of patients admitted to acute hospitals may be alcohol dependent. Yet, there remains considerable variation in provision of Alcohol Care Teams (ACT) in England, and a limited evidence base for understanding their clinical effectiveness. The NHS long-term plan has invested to ‘optimise’ ACT through the development of existing services and the establishment of new teams in 25% of hospitals in greatest need by 2024. The ProACTIVE research programme is a multi-disciplinary, integrated, mixed-methods study designed to evaluate the impact of ACT at macro (policy), meso (health system) and micro (patient) level. It will identify the ‘optimal’ models of ACT, define the components which best support the identification, and cost-effective management of hospitalised adults with alcohol dependence (AD), and will facilitate the rapid dissemination of the results. The ProACTIVE team is uniquely placed to deliver this national evaluation, combining expertise in health service and delivery methods, data and implementation science, clinical management of AD, and advocacy of lived experience. ProACTIVE has four interconnected work packages (WP): WP1 will build the first comprehensive national database of ACT provision in England, identify local stakeholders, define the range of components of care, agree a taxonomy for ACT interventions, and explore the reliability and linkage of nationally available data; WP2 will evaluate the clinical and cost-effectiveness of ACT, using a quasi-experimental naturalistic study of three ‘optimal’ ACT and three ‘minimal’/no ACT sites, following-up patients for six months to evaluate the micro level impact of ACTs. Meso level ACT impacts (e.g., re-admission rates, length of stay) will be assessed by an interrupted time series analysis using nationally available data. A parallel exercise will assess the cost-effectiveness of ACT at both meso and micro levels. As ACT effects may take time to emerge (e.g., impacts on health inequalities), a model will be built to generate estimates of how the health outcomes vary across socioeconomic groups, and the impact of introducing (or removing) an ACT on alcohol-related health inequalities; WP3 is a qualitative evaluation of?ACT using an organisational ethnographic case study?design to identify factors at macro, meso and micro levels that have shaped the composition, delivery, and impact of ACT. The integrated PPI team will ensure that each element of the research embraces co-design principles and integrates the experience of patients into the enquiry; WP4 will facilitate timely synthesis of findings from each phase of the evaluation, using the ‘Context and Implementation of Complex Interventions’ framework, and work with stakeholders to generate guiding principles for an optimised ACT, and toolkit for best practice in developing sustainable, patient focussed services. Given the NHS programme timelines, an ambitious timeframe of three years has been chosen to facilitate decision-making for future investment in ACT. Defining necessary components of an ACT – where and how they work best, and with whom is essential groundwork to grow the evidence base for which interventions are effective in this underserved patient group. Central to this, is the development of an ACT PPI network to co-produce evidence and tools with patients, policy makers and commissioners about the best use of NHS funds in this area.