title: A systems approach to care pathways into in-patient alcohol detoxification: outcomes from a retrospective study.
abstract: This paper describes the effects of the adoption of a systems approach to alcohol service delivery by four previously separate organisations in Manchester, UK that commenced in 1997. The study examined a database of 5542 admissions for in-patient detoxification between 1995 and 2003, which permitted the analysis of changes occurring in the composition of the client group after the adoption of the new model. Findings suggest that working with the systems approach resulted in more effective targeting of people with higher levels of alcohol dependency towards in-patient detoxification. Females and people in stable housing also benefited from increased access in the new system. Increases in planned discharges were observed across all demographic variables, although alcohol-dependent males without stable accommodation found it more difficult to access in-patient detoxification after the new model was introduced. We conclude that in comparison to a loose network of services a co-ordinated and managed service system can improve targeting for in-patient detoxification for most people with severe alcohol dependence but may not do so for all who need access.
authors.affiliation: Department of Mental Health Social Work, University of Manchester and Health and Social Care Advisory Service, UK. info@tonyryan.org
authors.forename: Tony
authors.initials: T
authors.lastname: Ryan
authors.forename: Lucy
authors.initials: L
authors.lastname: Webb
authors.forename: Petra S
authors.initials: PS
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways; D017598:Efficiency, Organizational; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013597:Systems Analysis; D006113:United Kingdom / Q000453:epidemiology