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NICE: Better Collection of Patients' Alcohol Use Needed

To ensure those who need help with alcohol-related problems are not missed, NICE is urging professionals to gather information on people's alcohol drinking habits correctly.

As the last orders bell rings on this year's Dry January, the National Institute for Health and Care Excellence (NICE) has warned that thousands of people each year could be "missing out" on brief interventions to help curb problem drinking, or a potential referral to specialist alcohol services.

In its new draft quality standard, "Alcohol-use disorders: diagnosis and management", the regulator sets out priority areas for quality improvement for the care of adults with alcohol-use disorders, encompassed in which is a statement about accurately recording alcohol use.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, commented: "Many of us are asked about our alcohol use when we interact with health services, but if an appropriate questionnaire is not used, people with alcohol problems could be slipping through the net and may not be receiving the support they need."

The Measure of Alcohol-Related Health Problems

At the end of last year, the Office for National Statistics (ONS) had said that in 2021 there were 9641 deaths from alcohol-specific causes registered in the UK, which equated to almost 15 deaths for every 100,000 (14.8 per 100,000) of the UK population. This was the "highest number since records began" over 20 years ago in 2001, the ONS pointed out. Figures in 2021 were up 7.4% on 2020 figures, and up a "staggering" 27.4% from 2019.

British Liver Trust Chief Executive, Pamela Healy OBE, commented: "Since the start of 2020, there has been a big shift in the UK's drinking culture with millions of us drinking more regularly and at home – pouring much larger measures than if drinking when out."

Asked to comment for Medscape News UK, Alcohol Change UK Chief Executive, Dr Richard Piper, said that: "Over 10 m people in the UK consume alcohol at levels that pose a risk to their health", and that the new guidance from NICE was "widely welcomed".

No Extra Rounds for Health Professionals – No Repeat Rounds for Patients

However, NICE highlighted that, in a study of the completeness and validity of alcohol recording in general practice (based on the Clinical Practice Research Datalink in 2018 of around 1.8 million adults), fewer than 10% had a record of either an AUDIT or FAST alcohol screening test score, and almost half had "no recorded alcohol consumption data at all"."People being asked about how much and how often they drink alcohol should have the information added to a validated questionnaire to identify if they need help," said NICE. It explained that using an appropriate validated alcohol questionnaire when asking people about their alcohol use will help identify if they should receive a suitable brief intervention or a referral to specialist alcohol services, according to "their needs and their identified level of risk".

Dr Piper highlighted that "around 600,000 people have severe alcohol dependency and will, as a result, benefit hugely from professional alcohol treatment", which, he underlined, "works". However, there is currently a "big problem", he alluded, since "only around 1 in 6 of the people who could benefit from alcohol treatment, actually take it up".

The alcohol use questionnaire may be completed by a member of staff, or by the individual patient themselves if they are able, NICE explained. The regulator was at pains to point out that the new draft quality standard "does not ask for health professionals to do additional work", but stressed that information gathered should be "correctly and appropriately" stored.

"This should also avoid people being asked repeatedly about their alcohol use," NICE emphasised.

Organise Appropriate Consumer Services

"We know a large number of people who are dependent on alcohol are not receiving treatment, and this could be for a variety of reasons, but as part of a health and care system that continually learns from data, we do know that using a validated questionnaire provides commissioners with the information they need to organise appropriate services," Dr Chrisp detailed.

The three other new quality statements within the draft consultation are:

  • People seeking help for an alcohol-use disorder are given information and support to access community support networks and self-help groups
  • Adults seen by specialist alcohol services have a brief triage assessment that includes comorbidities and associated risks
  • People in acute alcohol withdrawal in hospital are assessed and monitored following locally specified protocols

NICE has also updated the existing quality statement that now says: "People with moderate or severe alcohol dependence are offered psychological and, if appropriate, pharmacological interventions, to prevent relapse following a successful unplanned withdrawal."

Consultation on the five statements has begun and feedback can be made via until Tuesday 28 February 2023.