Navigation

Opportunistic screening and brief interventions

Quality statement

Health and social care staff opportunistically carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice.

Quality measure

Structure

a) Evidence of local arrangements to ensure that healthcare staff opportunistically carry out screening and brief interventions for hazardous and harmful drinking on a routine basis.

b) Evidence of local arrangements to ensure that social care staff opportunistically carry out screening with people who may be at an increased risk of harm from alcohol and people who have alcohol-related problems, and deliver brief interventions for hazardous and harmful drinking.

c) Evidence of local arrangements within the commissioning framework to ensure that brief interventions are reviewed to ensure effective practice.

Process

a) Proportion of people aged 16 years and over in the locally defined target population who receive alcohol screening.

Numerator - the number of people in the denominator receiving alcohol screening.

Denominator - the number of people aged 16 years and over in the locally defined target population for alcohol screening.

b) Proportion of people aged 18 and older identified as hazardous or harmful drinkers who receive structured brief advice.

Numerator - the number of people in the denominator receiving structured brief advice.

Denominator - the number of people aged 18 and older identified as hazardous or harmful drinkers.

c) Proportion of people aged 16 or 17 identified as hazardous or harmful drinkers and people aged 18 and older not responding to structured brief advice for hazardous or harmful drinking, who receive an extended brief intervention.

Numerator - the number of people in the denominator receiving an extended brief intervention.

Denominator - the number of people aged 16 or 17 identified as hazardous or harmful drinkers and people aged 18 and older not responding to structured brief advice for hazardous or harmful drinking.

Outcome: Decrease in the quantity and frequency of alcohol consumption in the locally defined target population.

Description of what the quality statement means for each audience

Service providers ensure that healthcare staff opportunistically carry out alcohol screening and brief interventions for hazardous and harmful drinking on a routine basis, and that social care staff opportunistically carry out alcohol screening with people who may be at an increased risk of harm from alcohol and deliver brief interventions for hazardous and harmful drinking.

Healthcare professionals ensure they opportunistically carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice and on a routine basis.

Social care professionals ensure they opportunistically carry out screening for people who may be at an increased risk of harm from alcohol and deliver brief interventions for hazardous and harmful drinking.

Commissioners ensure they commission services that opportunistically carry out screening and brief interventions for hazardous and harmful drinking as an integral part of practice, and develop commissioning frameworks that review this practice to ensure effectiveness.

People aged 16 and over are asked questions about their drinking during contact with health and social care professionals, and may be offered some brief advice about what this means or a longer session to help reduce their drinking.

Source clinical guideline references

NICE public health guidance 24 recommendations 5, 7 and 9.

Data source

Structure

a), b) and c) Local data collection.

Process

a) GP practices delivering the current Directed Enhanced Service (DES)specification for the Alcohol-related risk reduction scheme, England are required to send to commissioners an audit of:

  • Number of newly-registered patients aged 16 and over within the financial year who have had the shortened standard test (FAST or AUDIT-C - both abbreviated versions of the alcohol use disorders identification test [AUDIT]).
  • Number of newly-registered patients aged 16 and over who have screened positive using a short test during the financial year, who then undergo a fuller assessment using a validated tool (for example, AUDIT) to determine increasing risk, higher risk, or probable alcohol dependence.

The current National patient survey of PCTs collects the following data:

  • Whether people have been asked by someone at their GP practice/health centre in the last 12 months about how much alcohol they drink.

And data on respondents' discussions with their GP, someone else at the surgery, another doctor or any other medical professional is available from the Omnibus ONS drinking survey.

Contained within NICE public health guidance 24: audit support criteria 1, 4a, 4b and 5.

b) The DES requires participating GP practices to audit the number of newly-registered patients who have been identified as drinking at increasing risk or higher risk levels who have during that period received a brief intervention to help them reduce their alcohol-related risk. Contained within NICE public health guidance 24: audit support criterion 6.

c) Local data collection. Contained within NICE public health guidance 24: audit support criteria 3 and 8.

Outcome

Data on prevalence of alcohol misuse in adults is available by region from the NHS Adult Psychiatric Morbidity Survey in England

Definitions

The following definitions are adapted from NICE public health guidance 24.

‘Screening' involves identifying people who are not seeking treatment for alcohol problems but who may have an alcohol-use disorder. Practitioners may use any contact with clients to carry out this type of screening. The term is not used here to refer to national screening programmes such as those recommended by the UK National Screening Committee (UK NSC). Screening should be carried out with a validated alcohol questionnaire (such as the AUDIT).

‘Brief intervention' comprises either a short session of structured brief advice or a longer, more motivationally-based session (that is, an extended brief intervention). Both aim to help someone reduce their alcohol consumption (sometimes even to abstain) and can be carried out by non-alcohol specialists.

Screening and extended brief interventions are recommended in people aged 16 or 17 years. Screening and structured brief advice are recommended as the first step in people aged 18 years and older. For those who do not respond to structured brief advice, an extended brief intervention is recommended.

For the purposes of this statement, health and social care staff are defined as any professional working in any health or social care setting, including those working in criminal justice, prison, community or voluntary sector settings who regularly come into contact with people at risk of harm from the amount of alcohol they drink.

NHS professionals should consider discussing alcohol consumption during new patient registrations at a GP practice, when screening for other conditions, and when managing chronic disease or carrying out a medicine review. Discussions should also take place when promoting sexual health, when seeing someone for an antenatal appointment and when treating minor injuries.

Social care professionals should focus on people who may be at an increased risk of harm and people who have alcohol-related problems. People who may be at an increased risk of harm from alcohol include those:

  • at risk of self-harm
  • involved in crime or other antisocial behaviour
  • who have been assaulted
  • at risk of domestic abuse
  • whose children are involved with child safeguarding agencies
  • with drug problems.

Figure 5 in the full version of clinical guideline 115 provides a care pathway for case identification and possible diagnosis for adults, including criteria for brief interventions, extended brief interventions, and specialist referral.

Equality and diversity considerations

Lower screening thresholds may be needed when assessing older and younger people. In addition, by recommending that those aged 16 and 17 receive extended brief interventions (rather than structured brief advice) it may reduce the number of opportunities to receive an intervention, as extended brief interventions may be less readily available. Lower screening thresholds should also be considered for women and some black and minority ethnic groups too.

Discussions broaching the subject of alcohol and screening should be sensitive to people's culture and faith, and tailored to their needs. Discussions with young people should be sensitive to the person's age, their ability to understand what is involved and their emotional maturity. Relevant specialists should be consulted when it is not appropriate to use an English language-based screening questionnaire, for example when dealing with people whose first language is not English or who have a learning disability.

This page was last updated: 25 August 2011

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.