QOF Plus Year 1 - Imperial College London

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Priority and relevance to national policyAddressing alcohol misuse is a key priority for the Government. The Government’s Alcohol HarmReduction Strategy for England was published in 2004. In 2007, the Government followed thiswith a new publication: ‘Safe. Sensible. Social. The Next Steps in the National Alcohol Strategy’.The Review of the Effectiveness of Treatment for Alcohol Problems published by the NationalTreatment Agency (Raistrick et al., 2006) provides a comprehensive review of the researchsurrounding identification and management of alcohol problems. In his final report of the NHSNext Stage Review (2008), Lord Darzi listed the reduction of alcohol harm as one of the key goalsfor primary care trusts to address when commissioning comprehensive well-being and preventionservices, in partnership with local authorities…” The Department of Health and GeneralPractitioner Committee (GPC) have very recently released details of a new Directed EnhancedService (DES) for Alcohol, incorporating screening and brief interventions.Prevalence of conditionIn 2004 an estimated 8.2 million people in England aged 16-64 (26 percent of the totalpopulation) had an alcohol use disorder in England. 38 percent of these were men and 16 percentwere women (Drummond et al., 2004).Associated morbidity and mortalityExcess alcohol consumption is responsible for significant amounts of morbidity and mortality andcosts the health service £1.7bn per annum (Hutchings et al., 2006). Alcohol misuse is associatedwith up to 22,000 premature deaths in England and Wales annually, and a significant proportionof these are due to alcohol-related liver disease (Prime Minister’s Strategy Unit, 2004). Alcoholmisuse is responsible for over 30,000 hospital admissions per year for alcohol dependencesyndrome, and up to 70% of all admissions to accident and emergency departments at peak times(Leon et al., 2006). Annually, alcohol misuse is associated with approximately 14 percent ofdeaths from injuries, which involves about 1700 individuals. Alcohol misuse may be linked to 38-45 percent of deaths in fires, 7-25 percent deaths at work and 23-38 percent of deaths fromdrowning (Leon et al., 2006). Alcohol misuse may be a causal factor in up to 41 percent ofsuicides. Of those presenting to hospital with self harm, 50 percent were found to be regulardrinkers and 23 percent were dependent (Leon et al., 2006). 1.2 million violent incidents (aroundhalf of all violent crimes), 360,000 incidents of domestic violence (around a third), increased antisocialbehaviour and fear of crime, up to 17 million lost working days, between 780,000 and 1.3million children affected by parental alcohol problems, and an increased divorce rate have beenattributed to alcohol use (Cabinet Office, 2004). Alcohol is responsible for 3.5 percent of deathsfrom cancer in the UK, or 5000 deaths per year (Prime Minister’s Strategy Unit, 2003). Alcoholmisuse is also a risk factor for cardiovascular disease (Royal <strong>College</strong> of Physicians, 2001).28
Local contextThe Hammersmith and Fulham Public Health Report 2007/8 (Zeuner, 2008) states that:“It is estimated that 5.7% of adults aged 15-64 in Hammersmith and Fulham (7,300people) have an alcohol dependency, which is the highest prevalence in <strong>London</strong>.Hammersmith and Fulham has a particularly high prevalence of hazardous and harmfuldrinking. It is estimated that around 36,000 adults (25%) in Hammersmith and Fulhamconsume hazardous amounts of alcohol, and a further 10,000 adults (7%) consumeharmful amounts of alcohol. Given the socio - demographic characteristics of thepopulation, it is expected that approximately 16.4% (CI: 13.8% - 19.3%) of adults bingedrink (around 24,000 adults). Hospital admission rates for alcohol-specific and alcoholattributableconditions are high in Hammersmith and Fulham, particularly among males.Mortality rates for alcohol-specific and alcohol-attributable conditions are high inHammersmith and Fulham, particularly among males. The alcohol-specific mortality rateamong males is one of the highest in England. The mortality rate from chronic liverdisease among males in Hammersmith and Fulham is also one of the highest in England”.Review of evidence to support the proposed indicatorsThere is a significant amount of evidence supporting the effectiveness of opportunistic casefindingfor alcohol misuse and the delivery of brief interventions (Moyer et al., 2002). The resultsof many of the large-scale systematic reviews and meta-analyses are summarised in an evidencebriefing by the Health Development Agency (2005) and in the Scottish Intercollegiate GuidelinesNetwork (SIGN) guidelines. Strong evidence for the effectiveness of brief alcohol interventions inprimary care populations is also provided by a recent Cochrane Collaboration review (Kaner et al.,2007).The CAGE screening questionnaire was validated in 1974 and is the most widely used test inclinical practice (Smart et al., 1991). However, research by Aertgeerts et al. (2001) found that itwas not sufficient as a screening instrument for detecting alcohol misuse or dependence amongprimary care patients.The AUDIT was developed by the World Health Organisation (WHO) as a simple method ofscreening for excessive drinking (Saunders et al., 2003). AUDIT takes 5 minutes to complete, canbe administered through a brief, structured interview or a self-report questionnaire, and has asensitivity of 92% a specificity of 94% (Saunders et al., 2003).Abbreviated versions of the WHO Alcohol Use Disorders Identification Test (AUDIT)questionnaire, include the AUDIT-FAST (developed for use in A and E and other hospital settingsby Hodgson et al. in 2002, and now validated for use in primary care), the AUDIT-C and theAUDIT-PC (developed by Bush et al. in 1998 for use in primary care).29
Page 1: Towards world class healthcare for
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Page 10 and 11: CreditsProject boardJosip CarMiles
Page 12: AcknowledgementsWe are indebted to
Page 15 and 16: Executive summaryIntroductionPrevio
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Rosen et al. (2001) categorised ini
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The National 2007 Quality and Outco
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ReferencesBaker, R (2007) Quality a
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BackgroundThe United Nations Conven
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In March 2008, a PCT audit of signi
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Impact on health inequalitiesPovert
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Training and support requirements f
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Information on self-directed online
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New patient screeningProposed train
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Patient experienceLearning disabili
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Appendix 1Background to the QOF+ de
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Appendix 2Methodology for the exten
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PrevalenceRegistersizeAsthma 5.75%
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While both threshold types are remu
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The low level of remuneration for c
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Exception reportingMany QOF (and a
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indicators compared to national rat
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Appendix 3Current levels of attainm
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Percentage of practices at or below
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Appendix 4Methodology for the desig
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As a result of the prioritisation p
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Methodology for the development of
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Assessment of new clinical and reco
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Communication with the PCT’s heal
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Appendix 5Methodology for the devel
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Appendix 6Summary of the QOF+ schem
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QOF Plus Year 1 - Imperial College London

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