Text messaging service offers new approach to alcohol treatment pathway

Analysis reveals improvements in patient outcomes and reduction in re-referral rates for alcohol abusers

The use of mobile technology to support patients suffering from alcohol addiction has been found to reduce treatment failure rates and encourage better outcomes.

The results of a 20-month evaluation of the Bolton Alcohol Relapse Prevention Project have highlighted the potential of technology such as SMS mobile messaging to improve the health and wellbeing of patients.

The use of mobile phones is a novel and untried technology in the field of alcohol relapse prevention

Run by NHS Bolton, the programme makes use of existing technology to offer a new style of support for people wanting to cut their dependence on alcohol.

The initiative is supported by the Health Foundation's Shine project, which gives clinical teams the backing to try out their ideas for innovative approaches to improving the quality of care given to patients while saving costs.

And the analysis has revealed that similar schemes up and down the country could have a significant positive impact on future outcomes.

Developed by d2Digital by Design, the system has two main features: message reminders that ask about meeting attendance and appointments; and personalised support and monitoring, including asking how patients are coping, what their mood is like, and whether they could potentially relapse.

Prior to the implementation, keyworkers would manage all patients equally, potentially missing those about to relapse. The service providers now have access to an internet dashboard where they can monitor client responses either collectively or individually. They are then categorised and colour coded, with warnings of who is most at risk.

The findings of the research revealed that:

  • Engagement rates for clients enrolled the project were 72% compared to a baseline measurement of 42% (2009/10 figures)
  • In year re-referral rates for clients who had engaged on the project were 2% compared to 9% for those clients who were not engaged with the project
  • Clients who enrolled on the project were found to engage with the services for longer and achieved better outcomes
  • 69% of those engaged on the project completed treatment compared to 41% for those who did not take part

Helen Crisp, assistant director of research and evaluation at The Health Foundation, said: "At a time when health and social care services are facing a tough financial regime, it’s more important than ever that we find ways to reduce costs, while increasing the value of services.

We hope it will help other services who may want to develop support systems by mobile phone to understand how such a service needs to be planned and managed, together with the benefits that can result for service users and also for staff and for the health economy in terms of the better use of resources that can result

"The combined challenges of the financial downturn and increased demands due to the ageing population, increase in long-term conditions and the future demands on services being stored up from current eating, drinking and exercise behaviours are potentially creating a ‘perfect storm’ that services in their current form will struggle to weather.

"We hope it will help other services who may want to develop support systems by mobile phone to understand how such a service needs to be planned and managed, together with the benefits that can result for service users and also for staff and for the health economy in terms of the better use of resources that can result.

"Use of automated text messaging also has potential to be adapted into other fields of health and social care, where ongoing links with service users are vital to motivate people and can support aspects of self management such as monitoring correct medication use.

"Most importantly, the text messaging service has demonstrated tremendous support to people in the alcohol recovery programme, motivating them to stick with it. The feedback from clients is thought-provoking, showing how small steps in personalising services and providing a sense of continuity can help people to make difficult changes in their behaviour. The statistics on the service use and re-referral rates show the benefits that result when people stay with this aftercare programme.

"The team at Bolton have shown how using existing technology in an innovative way can make a real difference to improving the quality of care. By helping people to recover from alcohol dependency, the benefits are profound and long-lasting. They affect not only physical and mental health, but also employment opportunities, housing choices and relationships with family and more widely with the community."

The project was funded by NHS Bolton and The Health Foundation and involved 89 people.

The analysis found that it has the potential to save large sums of money because increased engagement prevents or delays future relapse and re-referral of clients, thereby reducing their future use of health and other services. These future savings can include any element of health service costs incurred by clients as they revolve around the treatment system, for example detoxification, emergency admission, ambulance services, inpatient treatment for a variety of alcohol-related conditions, primary care services etc. They also involve a myriad of non-health service costs including criminal justice, benefits, housing support etc.

The analysis estimates that the pilot prevented six re-referrals and if it had been taken up by all clients in aftercare could have prevented up to 13 re-referrals. For the purposes of the cost calculation the authors assumed that a likely number of re-referrals prevented might be somewhere between these two figures, say 10. By multiplying this number of prevented re-referrals with cost estimates of most-expensive, medium cost and least-expensive cases, a range of potential savings was achieved. These savings range from £68,000 to £400,000 over a single year.

These results suggest that the use of personalised mood/behaviour monitoring SMS technology can make a significant contribution to improved outcomes for alcohol clients in recovery

The report states: "Overall the positive responses from clients, carers and staff indicates that the project has had a far-reaching impact on the quality of service provision. The support the system offers, encourages ‘all’ clients to feel valued and supported at a crucial time in their recovery from alcohol dependency."

It concludes: "The use of mobile phones is a novel and untried technology in the field of alcohol relapse prevention. This project capitalised on the fact that mobile phones are becoming ever more central to the way we all communicate so that most clients are familiar with their use.

"We found that clients enrolled on the project were more likely to achieve goals at all points of the treatment pathway and were more likely to be discharged having completed the aftercare treatment with the community alcohol team. Furthermore the time taken for clients enrolled on the project to achieve their goals showed no increase over the time taken for other clients to achieve theirs and enrolled clients exhibited improved stability in other associated areas of their lives.

"These results suggest that the use of personalised mood/behaviour monitoring SMS technology can make a significant contribution to improved outcomes for alcohol clients in recovery. It also signifies potential efficiency savings for alcohol service providers and commissioners and indirect savings for the wider health and social care economy."

Click here to read the analysis in full.

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