Audit of complexity in a community addiction caseload

First published: 10 May 2019 | Last updated: 20 May 2019

Aims: Staff working in an integrated health and social work addiction service reported an increased workload because of high numbers of patients with complex presentations and needs.  The aim of this audit was to assess complexity in the team’s caseload (Service A) and to compare it with another team in a different part of the Health Service which operated in a similar way (Service B) which had not reported complexity as an issue.

Methods: A literature search did not identify any instrument for assessing complexity in an addiction caseload.  A tool was therefore constructed which used, for example, scales measuring the severity of a patients’ addiction problem, their frequency of contact with the addiction service and the number of other relevant agencies they had contact with to assess the complexity of individual patients. The use of this scale in interviews with staff in each service, with reference to patients’ case files, enabled patients to be placed in one of three categories of complexity: low, moderate or high. The percentage of patients in each category was calculated to allow comparison between the two services.

Results: Service A had a lower proportion of patients with low complexity as compared with service B (14% vs. 35%) but a higher proportion of patients with moderate complexity (59% vs. 50%) and high complexity (27% vs. 15%).

Conclusions: The audit met its aim in identifying different levels of complexity in two addiction services. The results suggest that levels of complexity should be taken into account when assessing service workload and when undertaking workforce and service planning.


Dr David Johnson, Consultant Psychiatrist (Addictions), NHS Highland, Argyll and Bute Hospital, Blarbuie Road, Lochgilphead, Argyll, PA31 8LD

Conflicts of interest:

Funded by the Argyll and Bute Addiction Team, NHS Highland.  There are no declarations of interest.


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Dr David Greenwell