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Brief interventions to curb alcohol use 'should be included in QOF'

GP practices should be incentivised through QOF to carry out alcohol screening and brief interventions in those with risky drinking habits, say researchers.

Their pilot in north-west London showed that a QOF ‘extra’ scheme to tackle alcohol use in certain patient groups led to an increase in screening for risky drinking among all patients, even in those not covered by the scheme.

The study supports a proposed QOF indicator on alcohol brief interventions in patients with hypertension proposed by NICE for the 2015/16 QOF.

The pilot, run at 30 practices in Hammersmith and Fulham between 2008 and 2011, awarded points for screening two groups of patients – people with or at risk of cardiovascular disease and those with a mental health condition – using the shortened AUDIT-C or FAST questionnaires.

The scheme further rewarded practices if patients who screened positive were then given brief interventions.

Among patients eligible for the QOF-extra points, the screening rate went up substantially from 4.8% in the pre-QOF-extra period to 65.7% after.

However, the screening rate also went up significantly, from 0.3% to 14.7%, among ineligible patients.

Of patients screened, a similar proportion – around 11–12% – of both eligible and ineligible patients screened positive for hazardous or harmful drinking, but 89% of the targeted group were then offered brief interventions compared with 74% of ineligible positive patients.

Reporting the findings in the Journal of Public Health, the authors wrote: ‘Financial incentives appear to be effective in increasing delivery of alcohol screening and brief interventions in primary care and may reduce hazardous and harmful drinking in some patients.’

They added: ‘The proportion of patients screening positive for problem alcohol use was similar in the unincentivised group as in those with conditions targeted by [QOF-extra], suggesting that applying alcohol screening and brief interventions more widely in primary care could identify more people at risk of alcohol related conditions.’

Lead author Dr Fiona Hamilton, clinical lecturer at Imperial College London and a former GP, told Pulse some of the improvement seen in the study could simply be down to improved recording and coding of alcohol screening, which was also being incentivised in new registrants at the time through a DES.

Dr Hamilton said: ‘Some of this might just be down to coding – GPs might have been doing this anyway but not coding it. However, there was a huge improvement in the proportion who were screened and then offered advice if they were positive, it did seem to be a success.

‘We also found people for whom this was not incentivised, although to a much lesser extent, they were also much more likely to be screened. So we thought there might be reason to make it even more of a prevention strategy.’

She added: ‘It’s part of NHS Health Checks now, so it looks like it’s on its way in – and interesting that NICE is looking at it for a QOF public health indicator for hypertension. If that shows a benefit they may extend to other conditions.’

J Pub Health 2013; online 26 Dec

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Readers' comments (2)

  • “But he has nothing on at all,” said a little child at last. “Good heavens! listen to the voice of an innocent child,” said the father, and one whispered to the other what the child had said. “But he has nothing on at all,” cried at last the whole people.
    Hans Christian Anderson, The Emperor’s New Suit

    And the benefits for patients outweigh the risks? We don’t know the answer to this because no-one has ever included ‘unintentional harms (CONSORT item 19)’ in the study protocol. Have NICE forgotten about including tolerability and safety as part of their assessment, or are their different rules for drug interventions and public health interventions?

    For example, would be good to do a follow-up study of screened patients and ask the following:

    How do you feel now that your records state that you have a drink problem? Can you get life insurance? Can you get health insurance? Can you get a mortgage? Have you been turned down for employment because of your alleged drink problem? Do you get lectured about drinking every time you visit a GP? Does this get on your wick? Does this put you off going to see your GP? Do you feel that you were tricked into revealing your drinking habits so the practice could earn a few quid? How do you feel about being listed as a problem drinker and for this information to be sold to private companies? Are you absolutely furious? Is your life in ruins? Are you taking legal action against the NHS? Did you feel that the patronizing chat with the nurse was useful?

    And the twenty-million dollar question . . . Did you actually cut-down drinking, or did you just lie on your second screen?

    There is NO EVIDENCE that brief intervention reduces what people ACTUALLY drink, just that on re-screen it reduces what they REPORT they drink: what people say and what people do are different things - isn' t this obvious? (yet the only group to question this flaw in methodology were shot down in flames by the alcohol research community who didn’t want to lose research funding).

    Will including alcohol screening in QOF cause more problems than it solves . . . ?

    For well-balanced, non-financial-agenda driven discussion, see the following papers:

    http://www.ncbi.nlm.nih.gov/pubmed/?term=Screening+and+brief+intervention+for+excessive+alcohol+use%3A+qualitative+interview+study+of+the+experiences+of+general+practitioners

    http://www.ncbi.nlm.nih.gov/pubmed/?term=Screening+and+brief+intervention+targeting+risky+drinkers+in+Danish+general+practice--a+pragmatic+controlled+tria

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  • I could not agree with the above more.....

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