The National Institute for Health Care and Excellence (NICE) is undertaking a consultation to review its guidance on prevention (PH24) and treatment (CG115), and new proposed QOF indicators for alcohol brief intervention in Primary Care.
QOF indicators: a boost for Primary Care IBA?
The Quality and Outcome Framework (QOF) forms a central part of the delivery of Primary Care services, involving a wide range of indicators to measure and incentivise performance against. A new set of alcohol QOF items are being proposed to help prompt alcohol brief intervention (also known as Identification and Brief Advice) when patients present with a number of illnesses or conditions commonly associated with alcohol misuse.
Whilst brief interventions technically form part of the GP contract for people registering with a new Primary Care practice, alcohol leads have long considered inclusion within the QOF a key objective for increasing brief intervention delivery in Primary Care. Alcohol brief intervention has the best evidence in Primary Care settings but has faced long-running questions over the extent and quality of delivery.
The new QOF indicators propose alcohol brief intervention as a routine part of care for patients with hypertension, mood disorders including depression and anxiety, other mental health problems and a range of physical health conditions including heart disease, stroke, diabetes and dementia. The QOF indicators consultation runs until Thursday 16 May 2019.
Alcohol prevention and treatment guidance: updating the evidence
PH24 was first released in 2010, providing a comprehensive evidence review and series of recommendations including minimum unit pricing and brief interventions. It was followed up in 2011 with CG115: harmful drinking and dependence and a series of further resources to support commissioners and other stakeholders.
The consultation document was developed following questionnaires sent to 21 topic experts from a range of stakeholder groups. The main issues raised by PH24 experts related to changes to how alcohol services are commissioned and delivered, new evidence on brief interventions, and overlap between PH24 and parts of CG115. The main issues raised by CG115 experts related to how alcohol services are commissioned and delivered, and new evidence on pharmacotherapies for withdrawal and relapse prevention. Comments were also made on a lack of resources affecting the delivery of recommendations, such as the provision of psychological services.
The consultation, intended for registered stakeholders, provides an overview of new evidence spanning a range of alcohol prevention areas including licensing. However, it identifies its intention is only to update PH24 in light of new evidence particularly regarding brief interventions in various settings and populations, but does not intend to update CG115 as currently further evidence is needed around digital interventions and pharmacotherapies for managing mild alcohol dependence and relating to withdrawal.
In particular, it sets out, for children and young people:
New published evidence indicates that an AUDIT-C threshold of 3 may be helpful in identifying at-risk alcohol use in young people aged 10 to 17 years, whilst an AUDIT score of 7 was more effective at identifying alcohol dependence. This evidence could be used to provide greater clarity on screening thresholds in young people aged 10 to 17 years and could change the recommendations – currently the guideline advises to use professional judgement as to whether to revise the AUDIT scores downwards when screening younger people (under the age of 18).
Concerning brief advice for adults:
There has been a large amount of new evidence published on brief interventions for adults in various settings and delivered by different practitioners and to different populations. The published evidence indicates that the effectiveness of brief interventions is modified by the setting, practitioner delivering the intervention and population receiving the advice. Topic expert feedback also highlighted that not all settings should be delivering brief interventions, but only those settings where it has been proven to be effective.
Concerning extended brief interventions for adults:
New published evidence on extended brief interventions seems to indicate that interventions may not be effective in all populations and settings. Currently the NICE guideline PH24 recommends offering extended brief interventions to all adults who have not responded to brief structured advice, but does not specify the setting or populations to target.
The document also states NICE is currently developing a guideline on 'Behaviour change: technology-based interventions' which will cover digital interventions for hazardous drinking, rather forming part of PH24. Digital interventions for harmful drinking however are within scope of the current CG115 surveillance review. Earlier this year NICE consulted on school based alcohol interventions.
Although aimed at registered stakeholders, the consultation states it can accept comments from individuals which will be considered, but won’t get a formal response and won’t be posted on the NICE website. However NICE encourage people to submit comments through a registered stakeholder organisation where possible. The consultation closes on 5pm on Wednesday, 8 May 2019.
In addition to NICE alcohol guidance, Public Health England also provide a range of alcohol related guidance and resources.
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