Figure 1
Participant flow diagram for the IMPACT service.
Table 1
Comparison of ED attendances and hospital admissions per month among IMPACT and comparison clients in the 6 months prior to, during (IMPACT group only), and in the 6 months post-IMPACT involvement. ED attendances are categorised as either preventable or non-preventable (ED attendances at the non-SESLHD hospital were unable to be reviewed and are presented as unassigned), and admissions are classified as substance use-related or not.
| ED attendances per month | IMPACT Group (n = 34) | Comparison Group (n = 12) | |||||
|---|---|---|---|---|---|---|---|
| 6-months prior | During IMPACT | 6-months post IMPACT | Comparison of prior and post* | 6-months prior | 6-months post-assessment | Comparison of prior and post* | |
| mean (SD) median (95% CI) | Z, p | mean (SD) median (95% CI) | Z, p | ||||
| Preventable | 0.9 (0.9) | 0.7 (0.7) | 0.4 (0.7) | – | 0.7 (0.8) | 0.5 (1.0) | – |
| 0.5 (0.3, 1.2) | 0.5 (0.3, 0.8) | 0.2 (0.0, 0.3) | –2.493, 0.013 | 0.3 (0.0, 1.3) | 0.2 (0.0, 0.5) | –0.638, 0.523 | |
| Non-preventable | 0.3 (0.4) | 0.2 (0.4) | 0.1 (0.6) | – | 0.4 (0.4) | 0.1 (0.1) | – |
| 0.2 (0.0, 0.3) | 0.1 (0.0, 0.2) | 0.0 (0.0, 0.0) | –2.613, 0.009 | 0.4 (0.2, 0.7) | 0.0 (0.0, 0.2) | –2.582, 0.010 | |
| Unassigned | 0.2 (0.6) | 0.5 (1.0) | 0.1 (0.3) | – | 0.8 (1.4) | 0.5 (0.6) | – |
| 0.0 (0.0, 0.0) | 0.0 (0.0, 0.3) | 0.0 (0.0, 0.0) | –0.827, 0.408 | 0.1 (0.0, 1.3) | 0.2 (0.0, 1.0) | –0.339, 0.735 | |
| All | 1.4 (1.2) | 1.4 (1.4); | 0.7 (0.9); | – | 1.9 (2.0) | 1.1 (1.3) | – |
| 1.0 (0.7, 1.7) | 1.2 (0.6, 1.4) | 0.2 (0.0, 0.7) | –2.868, 0.004 | 1.2 (0.5, 2.0) | 0.7 (0.2, 1.8) | –1.930, 0.054 | |
| Hospital admissions per month | mean (SD) median (95% CI) | Z, p | mean (SD) median (95% CI) | Z, p | |||
| Substance use related | 0.5 (0.4) | 0.4 (0.5) | 0.2 (0.3) | – | 0.2 (0.3) | 0.1 (0.2) | – |
| 0.3 (0.2, 0.5) | 0.2 (0.0, 0.5) | 0.0 (0.0, 0.2) | –3.008, 0.003 | 0.0 (0.0, 0.3) | 0.0 (0.0, 0.2) | –0.595, 0.552 | |
| Unrelated to substance use | 0.3 (0.4) | 0.3 (0.4) | 0.1 (0.3) | – | 0.2 (0.3) | 0.2 (0.5) | – |
| 0.2 (0.0, 0.3) | 0.2 (0.1, 0.3) | 0.0 (0.0, 0.2) | –2.043, 0.041 | 0.2 (0.0, 0.3) | 0.0 (0.0, 0.2) | –1.317, 0.188 | |
| All | 0.8 (0.5) | 0.7 (0.6) | 0.3 (0.5) | – | 0.4 (0.5) | 0.3 (0.5) | – |
| 0.7 (0.5, 1.0) | 0.7 (0.3, 0.9) | 0.2 (0.0, 0.3) | –3.467, 0.001 | 0.3 (0.2, 0.5) | 0.0 (0.0, 0.3) | –1.299, 0.194 | |
[i] * Wilcoxon signed-rank test.
Table 2
Comparison of Emergency Department (ED) attendance and hospital admissions total costs in Australian Dollars (financial year 2015–2016 equivalent) among IMPACT and comparison clients, in the 6 months prior to, during (IMPACT group only), and in the 6 months post-IMPACT involvement. ED attendances are categorised as either preventable or non-preventable (ED attendances at the non-SESLHD hospital were unable to be reviewed and are presented as unassigned), and admissions are classified as substance use related or not.
| ED attendances total cost | IMPACT Group (n = 34) | Comparison Group (n = 12) | |||||
|---|---|---|---|---|---|---|---|
| 6-months prior | During IMPACT | 6-months post IMPACT | Comparison of prior and post* | 6-months prior | 6-months post-assessment | Comparison of prior and post* | |
| mean (SD) median (95% CI) | Z, p | mean (SD) median (95% CI) | Z, p | ||||
| Preventable | 3,598 (3,397) | 3,224 (4,174) | 1,858 (2,853) | – | 2,181 (2,430) | 2,060 (3,409) | – |
| 2,647 (1,370, 3,769) | 1,868 (1,035, 3,659) | 630 (0, 2,070) | –2.687, 0.007 | 1,035 (0, 5,068) | 459 (0, 3,105) | –0.059, 0.953 | |
| Non-preventable | 1,561 (2,346) | 1,246 (2,144) | 883 (3,552) | – | 1,968 (1,635) | 373 (493) | – |
| 1,035 (0, 1,479) | 630 (0, 1,035) | 0 (0, 0) | –2.339, 0.019 | 1,633 (918, 3,046) | 0 (0, 815) | –2.667, 0.008 | |
| Unassigned | 1,122 (2,806) | 1,888 (3,427) | 392 (966) | – | 2,592 (4,539) | 999 (1,237) | – |
| 0 (0, 0) | 0 (0, 1,443) | 0 (0, 0) | –1.070, 0.285 | 204 (0, 5,393) | 408 (0, 2,226) | –1.352, 0.176 | |
| All | 6,281 (4,577) | 6,359 (6,066) | 3,133 (4,415) | – | 6,741 (5,309) | 3,432 (4,478) | – |
| 5,220 (3,166, 8,074) | 3,746 (2,760, 8,510) | 1,035 (0, 3,808) | 2.998, 0.003 | 4,751 (3,282, 7,734) | 1,490 (630, 3,215) | –2.118; 0.034 | |
| Hospital admissions total cost | mean (SD) median (95% CI) | Z, p | mean (SD) median (95% CI) | Z, p | |||
| Substance use related | 11,720 (12,974) | 11,988 (17,111) | 8,066 (28,129) | – | 4,120 (6,809) | 1,688 (3,536) | – |
| 9,870 (4,644, 14,515) | 6,685 (0, 11,684) | 0 (0, 602) | –2.629, 0.009 | 0 (0, 7,537) | 0 (0, 2,021) | –1.041, 0.310 | |
| Unrelated to substance use | 13,631 (23,332) | 15,679 (28,452) | 6,842 (15,256) | – | 5,927 (7,466) | 884 (1,919) | – |
| 782 (0, 11,592) | 5,621 (609, 10,479) | 0 (0, 2,027) | –1.380, 0.168 | 4,971 (0, 9,622) | 0 (0, 667) | –2.111, 0.035 | |
| All | 25,351 (23,496) | 27,667 (35,717) | 14,908 (40,737) | – | 10,047 (9,443) | 2,572 (3,629) | – |
| 15,935 (12,106, 26,736) | 14,641 (7,352, 25,077) | 602 (0, 9,201) | –3.096, 0.002 | 6,273 (4,971, 13,113) | 0 (0, 4,971) | –2.189, 0.029 | |
[i] * Wilcoxon signed-rank test.
Table 3
Baseline and follow up client-reported outcomes for the 23/34 IMPACT clients with an Australian Treatment Outcomes Profile completed.
| ATOP item | Number of clients with ATOP item available | Baseline | Follow-up | p |
|---|---|---|---|---|
| Days primary substance use in previous 28, mean (95% CI) | 23 | 19 (15, 22) | 11 (6, 15) | 0.003* |
| Psychological health, self-rated on a 0 (poor)-10 (good) scale, mean (95% CI) | 17 | 5.2 (4.1, 6.4) | 6.1 (4.7, 7.6) | 0.209* |
| Physical health, mean (95% CI) | 16 | 4.6 (3.3, 5.9) | 5.7 (4.4, 7.0) | 0.142* |
| Quality of life, mean (95% CI) | 17 | 4.6 (3.4, 5.9) | 6.3 (4.7, 7.9) | 0.054* |
| Homeless/at risk in previous 28 days, % (95% CI) | 22 | 26% (11%, 50%) | 35% (17%, 59%) | 0.688** |
| Been arrested, % (95% CI) | 23 | 13% (3%, 34%) | 13% (3%, 34%) | 1.000** |
| Any violence, % (95% CI) | 23 | 43% (23%, 65%) | 22% (7%, 44%) | 0.180** |
| Any employment/education, % (95% CI) | 23 | 17% (5%, 39%) | 13% (3%, 34%) | 1.000** |
[i] * Paired t-test.
** McNemar’s test and binomial test with Copper-Pearson exact confidence intervals.
Figure 2
Clinical Global Impression-Improvement scores for 30 out of 34 clients of the IMPACT service (excluding 3 deceased clients and 1 unable to be rated), a 7-point scale whereby treating clinicians globally rate the level of improvement in the client condition over the course of the treatment episode (1 = very much improved since initiation, 2 = much improved, 3 = minimally improved, 4 = no change, 5 = minimally worse, 6 = much worse, 7 = very much worse). Clients were scored on global health, substance use, mental health, physical health and quality of life domains. Client outcomes were considered ‘improved’ for scores of 1–3, ‘no change’ for scores of 4, or ‘deteriorated’ for scores of 5–7.
| ACM | Assertive Community Management |
| ATOP | Australian Treatment Outcomes Profile |
| CGI-I | Clinical Global Impressions – Improvement |
| CL | Consultation/Liaison |
| D&A | Drug and Alcohol |
| ED/s | Emergency Department/s |
| IMPACT | Integrated Management Pathways for Alcohol & drug Clients into Treatment |
| SESLHD | South Eastern Sydney Local Health District |
| SUD/s | Substance use disorder/s |