Transcript a qualitative study of people who repeatedly

Frequent attenders to A&E departments: a
qualitative study of people who repeatedly
present with alcohol-related health
conditions
Tom Parkman, Jo Neale, Ed Day, Colin Drummond
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Background
• The term AFA is unclear, contested and potentially pejorative
• Very little is known about AFAs
• AFAs do not appear in policy documents and there are few
interventions specifically targeted at them
• In the absence of factual information, AFAs are at risk of
stereotyping and/ or misplaced policies and interventions
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Stereotypes and prejudice
Social categorisation
The process whereby a person is not seen as a unique individual, but as a member of a group of
people based on common characteristics
Stereotyping
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Beliefs are based on the characteristics of
groups of people
Linkages are made between individuals, a
social category and traits of that category
Stereotypes are not necessarily harmful, but
can become harmful if inaccurate information
is erroneously attributed to a social group
Prejudice
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Prejudice goes further than stereotyping &
includes an emotional component (often
negative)
Prejudice can can result in individuals being
verbally rejected, discriminated against,
stigmatised and marginalised from society
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Presentation aim & methods
• Aim:
• To increase understanding of AFAs’ demographic characteristics,
substance use, social circumstances, and patterns of A&E attendance
• Definition of AFA used:
• “Any patient aged 16 or over who attends any A&E department 10 or
more times within a year or 5 or more times within a 3-month period for
an alcohol–related condition” (ISD Scotland, 2011)
• Methods:
• In-depth qualitative interviews with 30 AFAs from 6 hospitals in greater
London (February – June 2015)
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Demographic characteristics
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Mean age: 48 years (range = 20 – 68 years)
Gender: 18 males, 12 females
Employment status: 28 unemployed, 1 employed, 1 self-employed
Income: Employment Support Allowance (ESA), Disability Living
Allowance (DLA), wage for those employed
• Education: no qualifications (n=9), GCSE (n=12), A-levels (n=5),
university degree or higher (n=4)
• Ethnicity: White British (n = 19), Asian British (n=4), Mixed Race
(British) (n=3), European (n=3), Other (n=1)
• Ever been in prison: n = 6
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Substance use
• Alcohol:
• 29/30 reported many years of heavy drinking
• Illicit drug use:
• 20/30 said they had never tried drugs
• 5/30 reported a history of drug dependence (cocaine, heroin,
crack, mephedrone, Valium)
• 4/30 reported smoking cannabis in the past
• 1/30 active drug user (IV heroin)
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Mental health
• Diagnosed: Depression, bipolar, personality disorder, borderline personality disorder,
dementia, agoraphobia, bulimia
• Undiagnosed: Depression, anxiety, hearing voices, seeing faces
• Stress-related: Generalised stress, loneliness, boredom
• Drinking-related: Vascular dementia, cerebral cellular atrophy
• Self and identity-related: No self-worth, no self-confidence, self-loathing, selfjudgement, rejection of ‘alcohol dependent’ label in favour of ‘binge drinker’
• Memory-related (caused by alcohol abuse): Short & long-term memory problems
• Emotional instability: ‘Mixed up emotions’, anger issues
• Self-reported explanations: Childhood bereavement, trauma, rape, sexual abuse,
physical abuse, family problems, deteriorating health
• Self-reported consequences: Addiction, suicide attempts, self-harm
Drinking always used to self-medicate MH problems
“They tell me I'm looking great, I'm putting weight on, I'm looking well. But the
façade looks good. We've all got a great façade, but inside sometimes I'm
crumbling” (Ppt 3; Male)
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Physical health
• Alcohol-related:
• Chronic conditions: Diabetes, liver failure, kidney failure, gastritis, hepatitis,
pancreatitis, high blood pressure, incontinence, angina, respiratory problems,
stroke, anaemia, heart attacks, peripheral neuropathy
• Physical trauma: Broken bones (from falling over)
• General ill-health: Bad teeth, problems with sleeping, malnutrition, weight
gain/loss, persistent vomiting, malaise
• Non alcohol-related:
• Physical disabilities: Guillain-Barre syndrome, blindness, physical immobility
• Good health: Feel ‘fine’, ‘ok’ (n=3)
Drinking always used to self-medicate physical health problems
“My liver's failing again. One kidney's packed up, one's working. I've got lung cancer,
I've got pancreatitis, I've got hepatitis, I've got everything you can imagine and I'm
terminally ill and I'm going to die soon” (Ppt 26; female)
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Housing circumstances
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Local authority/ housing association (n = 8)
Homeless (n = 6)
Hostel, YMCA or sheltered housing (n = 5)
Owner occupier (n = 4)
Living with friends/family (n = 3)
Private renting (n = 3)
Medical centre (n = 1)
Participants regularly discussed housing instability as a reason for drinking
“It [housing] is a big issue for me at the moment. That [house] is where I did all
my drinking when it got really bad. I would say that’s where it all happened…
Maybe I’ll change my mind. I don’t know. But if I was to go home tomorrow, it
would just be a bad move on my part. I don’t really want to go back there.”
(Ppt 27; Female)
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Family and social networks
• Harmful/no relationships:
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Pro drinking/drug using relationships
Abusive relationships
Relationship breakdown
Social isolation
Boredom
Loneliness
Bereavement
“I could be in a room full of people and still feel really alone.” (Ppt 19; Male)
Negative or no relationships were reasons for continued drinking
• Good relationships:
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Non-drinking friends and family
Perceived positive relationships
Abstinent friends and/or family
Peers in recovery
“She does the cooking, everything. She does the gardening, she does the… hoovering,
cleaning, everything… She won’t let me do anything.” (Ppt 23; Male)
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A&E attendances
• Attendances (last 12 months): Mean = 24 (range = 10 – 84)
• Admissions (last 12 months): Mean = 5 (range = 0 – 17)
• Drink-related reasons: Intoxication, withdrawal, physical health problems, self-harm,
overdose, suicide attempts, mental breakdown
“Every time I call up 999, I’m drunk, I’m completely drunk… and I feel suicidal… Every time,
I want to kill myself.” (Ppt 28; Female)
• Non-drink related reasons:
• Health problems: Pain, neurological problems, asthma attacks
• Lack of alternative health care: No access to/ availability of GP
• Social problems: Homelessness, violence
• Non medical problems: Hypochondria, self-reported ‘fake suicide attempts &
overdoses’
• Reasons for returning to A&E: Warmth, safety, always open, provides immediate help,
provides companionship, is the preferred service, perceived as providing better care,
offers free sandwich/cup of tea, clothes are washed, referred there by other services,
others call an ambulance
“If I had nowhere else… For safety… because I’m vulnerable.” (Ppt 15; Male)
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Reason for attendance at A&E included drink, and non-drink related reasons
Conclusions & implications
• AFAs have multiple and complex needs
• AFAs are a very diverse group in terms of their demographic characteristics,
drinking and wider substance use, health and social needs, access to
physical and social capital, and patterns of A&E attendance
• This diversity needs to be highlighted and recognised to:
• a) prevent stereotyping and labelling, with the attendant risks of harmful
prejudice, stigma and discrimination
• b) ensure policies and services/ interventions are sufficiently flexible and
response to individual needs and circumstances
• c) provide A&E staff with the necessary support, resources and training
to enable appropriate referral and/ or care management within
emergency departments
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Thanks for listening
Any questions?
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