A mixed-methods evaluation of the development and implementation of a high-quality alcohol assertive outreach treatment service

Background: Alcohol Assertive Outreach Treatment (AAOT) is an evidence-based model of care for people with alcohol dependence and complex comorbidities. Fidelity to the high-quality model may improve health outcomes yet information is lacking regarding optimal implementation. This study aimed to evaluate the implementation of a new high-quality AAOT service. Method: Mixed-methods design comprising quantitative analysis of AAOT service-user data (n = 40), including health outcomes and hospital use; qualitative interviews with nine service-users and three stakeholders; and a focus group with four AAOT staff. Qualitative data were analyzed using Framework Analysis informed by Proctor’s Taxonomy of Implementation Outcomes. Results: Fidelity to the high-quality AAOT model was achieved. At 6 months, 29.6% of the cohort were abstinent; the remainder showed significant reductions in units of alcohol consumed after 3 months (p =.012). At 6 months, psychological health (p <.001), physical health (p =.039), and quality-of-life (p <.001) had significantly improved, and hospital attendances (p=.019) and admissions (p=.009) significantly decreased. Qualitative analyses indicated participants felt AAOT was acceptable, appropriate, and highlighted facilitators and barriers to service delivery. Conclusions: High-quality AAOT services can be successfully implemented into existing services with adequate support, and can achieve high fidelity, and significant benefits to service-users.