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Independents' Day

NICE to pilot alcohol screening QOF indicator

GPs could receive QOF points for screening certain patients for problem drinking and delivering brief interventions, under plans revealed by NICE advisors today.

The proposed indicator would target patients with conditions – such as hypertension – where alcohol abuse is known to have adverse effects.

The NICE Primary Care Quality and Outcomes Framework Indicator Advisory Committee ruled out universal screening for alcohol as unworkable, but recommended that screening and interventions in certain groups should be piloted.

The recommendation was based on strong new evidence from the UK SIPS trial about to be published in the BMJ, which showed that brief interventions by GPs – such as giving a leaflet - were effective in helping patients at risk of alcohol problems.

The committee heard that there was a strong political pressure to tackle the growing problem of alcohol abuse, but GP members expressed strong reservations about using QOF incentives to promote universal screening.

One GP member of the panel said population screening for alcohol problems was ‘not backed by evidence’, the interventions could be difficult to deliver and there were implications for insurance and mortgage applications for patients with recorded alcohol interventions.

‘Alcohol abuse is a huge public health problem but QOF is not the right tool to fix it,’ the GP said.  ‘We should be looking at areas where alcohol has adverse effects rather than screening the whole population.’

NICE committee chair Dr Colin Hunter, a GP in Aberdeen, agreed, saying it would be better to select three chronic disease areas in QOF where alcohol is known to worsen outcomes and then develop a pilot initiative for indicators in these areas.

The committee heard that the SIPS Trial provided good evidence that brief interventions were effective for alcohol problems, and that giving a leaflet was more cost effective than more intensive one-on-one counselling.

Readers' comments (1)

  • The problem with the SIPS trial is that the results are not generalizable to a cross-sectional general practice setting because the trial included people who gave consent for inclusion. The study population is biased towards those who are willing to be included and therefore willing to alter their behavior. How would the results look if those who declined enrollment are included in the analysis as ‘intervention failures’? Furthermore, there are no patient acceptability data for opportunistic screening because acceptability is impossible to assess in a trial setting as bias is introduced when the patient gives consent.

    In the real world, Mr Smith attending with an ingrown toenail could unwittingly end up with a diagnosis of problem drinking, which would have serious implications for insurance and mortgage applications, yet no impact whatsoever on his drinking habits (other than perhaps to increase his intake due to the stress of losing his home). Politically-motivated, not evidence-based, opportunistic alcohol screening would cause more problems than it solves.

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