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NICE consults on new alcohol dependence and chronic heart failure draft quality standards

NICE has today (19 January) launched a consultation on its draft quality standards for the diagnosis and management of alcohol dependence[1]and harmful alcohol use in people aged 10 years and older, and the assessment, diagnosis and clinical management of chronic heart failure[2] in adults.

NICE quality standards aim to help healthcare practitioners, commissioners and service providers deliver the highest levels of quality, evidence-based patient care. They are developed from the best available evidence (usually NICE guidance or NHS Evidence-accredited sources), and are the only health and social care standards that apply nationally in England. NICE quality standards will play a key role in the new NHS Outcomes Framework, an overview of aims and objectives in improving patient outcomes in the NHS.

Alcohol dependence affects around 4% of the population in England aged between 16-65 years old, around 1.1 million people[3]. Over 24% of adults in the UK consume alcohol in a way that is potentially or actually harmful to their health or wellbeing[4]. Alcohol misuse is also an increasing problem in children and young people in England, with an estimated thirteen children a day admitted to hospital as a result of drinking alcohol.[5]

Heart failure affects about one in every 100 people in the UK, rising to one in every 15 for those aged 75 and over. Around 30% of patients admitted to hospital for heart failure die within a year of their hospital admission.[6]

The draft quality standard on alcohol dependence has 21 statements to help improve care for people drinking harmfully or with alcohol dependence, including the following:

  • People who misuse alcohol are treated in a respectful, non-judgmental manner and receive verbal and written information appropriate to their circumstances.
  • Adults accessing treatment in specialist alcohol services receive a motivational intervention as part of their initial assessment.
  • People needing specialist assessment or treatment for alcohol misuse, including those drinking harmfully who have not responded to an extended brief intervention and people with identified alcohol dependence, are referred to specialist alcohol services.
  • Adults and young people who are homeless and receiving specialist treatment for alcohol dependence are supported to find stable accommodation.

The draft quality standard on chronic heart failure features 14 statements that define high quality patient care, including:

  • People with stable chronic heart failure receive a supervised group exercise-based cardiac rehabilitation programme that includes education and psychological support.
  • People admitted to hospital because of chronic heart failure are provided with a personalised management plan that is shared with their carer(s) and GP, and are discharged only when stable.
  • People with severe heart failure, and their carer(s), have access to a heart failure specialist and specialist palliative care services.

The draft quality standards are now available on the NICE website for consultation which allows stakeholders to comment and help identify which statements are most important to support service improvement.

Dr Fergus Macbeth, Centre for Clinical PracticeDirector at NICE said: “Both alcohol dependence and chronic heart failure are very serious conditions, so it is important that there are standards in place that will help healthcare providers and commissioners provide the best high quality, evidence based care for patients. I would urge all those with an interest in these areas to submit their comments on these draft standards via the NICE website.”

These draft standards have been issued for consultation; NICE has not yet published the final quality standards to the NHS.

The draft standards are available for consultation on the NICE website from Wednesday 19 January until 5.00pm on Wednesday 16 February.

All eligible comments will be reviewed by the independent Topic Expert Group and the Programme Board, and the standards will be refined in light of this information. The final quality standards for alcohol dependence and chronic heart failure are expected to be published in June 2011.

Ends

Notes to Editors

  1. People who misuse alcohol are treated in a respectful, non-judgmental manner and receive verbal and written information appropriate to their circumstances.
  2. People who misuse alcohol are identified, assessed and receive interventions delivered by appropriately trained, competent and specialist staff in accordance with NICE guidance.
  3. Health, social care and substance misuse professionals routinely carry out alcohol screening and deliver effective brief interventions to hazardous and harmful drinkers as an integral part of practice.
  4. People needing specialist assessment or treatment for alcohol misuse, including those drinking harmfully who have not responded to an extended brief intervention and people with identified alcohol dependence, are referred to specialist alcohol services.
  5. People needing specialist treatment for alcohol misuse are able to access specialist alcohol services in a timely way.
  6. Adults accessing specialist alcohol services receive (via validated measures) a composite initial assessment and, if they are identified as needing structured treatment, all outstanding components of a comprehensive assessment.
  7. Children and young people accessing services for alcohol use receive a comprehensive assessment of multiple areas of need using a validated measure.
  8. Families and carers of people who misuse alcohol have their needs identified and receive support and information.
  9. Adults who misuse alcohol and have comorbid depression or anxiety disorders have their alcohol misuse treated first unless they have a severe mental health disorder or they are assessed to be at high risk of suicide.
  10. Adults who misuse alcohol and have comorbid depression or anxiety disorders have their mental health reassessed after 3 to 4 weeks of abstaining from alcohol.
  11. Adults accessing treatment in specialist alcohol services receive a motivational intervention as part of their initial assessment.
  12. Adults drinking harmfully and people with mild alcohol dependence receive evidence-based psychological interventions.
  13. People receiving treatment for alcohol misuse have the outcome of their treatment reviewed regularly, which they have the opportunity to discuss, and which is used to plan their subsequent care.
  14. Adults in vulnerable groups with moderate or severe alcohol dependence receive interventions to promote abstinence and prevent relapse as part of an intensive structured community-based intervention.
  15. Children and young people who misuse alcohol receive individual cognitive behavioural therapy, or if they have significant comorbidities or limited social support, a multicomponent programme of care including family or systems therapy.
  16. People who need medically assisted alcohol withdrawal are managed within a setting appropriate to their age, level of alcohol dependence, social support and any physical or psychiatric comorbidities.
  17. Adults and young people who are homeless and receiving specialist treatment for alcohol dependence are supported to find stable accommodation.
  18. People in vulnerable groups who are in acute alcohol withdrawal are admitted to hospital for medically assisted withdrawal and referred to specialist alcohol services at discharge from hospital.
  19. People undergoing medically assisted alcohol withdrawal are prescribed drug regimens appropriate to the setting in which their withdrawal is managed and adults have the opportunity to receive relapse prevention medication as soon as possible after starting withdrawal.
  20. Adults and young people with suspected or at high risk of developing Wernicke's encephalopathy receive thiamine in accordance with NICE guidance.
  21. People with Wernicke-Korsakoff syndrome with moderate or severe cognitive impairment are provided with long-term placement in supported 24-hour care that is adapted for people with cognitive impairment and where help is provided to maintain abstinence from alcohol.
  1. People presenting in primary care with suspected heart failure without previous myocardial infarction have their serum natriuretic peptides measured.
  2. People presenting in primary care with suspected heart failure without previous myocardial infarction are referred for specialist assessment including echocardiography if they have elevated serum natriuretic peptide levels, in accordance with NICE guidance.
  3. People presenting in primary care with suspected heart failure and previous myocardial infarction are referred for urgent specialist assessment including echocardiography.
  4. People with suspected heart failure referred for specialist assessment including echocardiography receive a timely and accurate diagnosis.
  5. People with chronic heart failure are offered personalised information, education, support and opportunities for discussion throughout their care that enable them to understand their condition and be involved in its management, if they wish.
  6. People with chronic heart failure are cared for by a multidisciplinary heart failure team led by a specialist and consisting of professionals with appropriate competencies from primary and secondary care, and are given a single point of contact for the team.
  7. People with chronic heart failure due to left ventricular systolic dysfunction are prescribed angiotensin-converting enzyme inhibitors and beta blockers licensed for heart failure, which are gradually increased up to the optimal dose with monitoring after each increase.
  8. People with chronic heart failure due to left ventricular systolic dysfunction who remain symptomatic despite optimal doses of an angiotensin-converting enzyme inhibitor and a beta blocker licensed for heart failure are considered for further medication after specialist advice, in accordance with NICE guidance.
  9. People with stable chronic heart failure receive a supervised group exercise-based cardiac rehabilitation programme that includes education and psychological support.
  10. People with stable chronic heart failure receive a clinical assessment at least every 6 months including a review of medication and renal function measurement.
  11. People with chronic heart failure whose clinical condition or drug treatment has changed, or who have been hospitalised for heart failure, receive a clinical assessment within 2 weeks, including a renal function measurement.
  12. People admitted to hospital because of heart failure receive input to their management plan from a specialist in heart failure.
  13. People admitted to hospital because of chronic heart failure are provided with a personalised management plan that is shared with their carer(s) and GP and are discharged only when stable.
  14. People with severe heart failure, and their carer(s), have access to a heart failure specialist and specialist palliative care services.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients.

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

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[1] Alcohol dependence is characterised by craving, tolerance, and a pre-occupation with alcohol and continued drinking in spite of its harmful consequences, such as liver disease or depression. Alcohol dependence is also associated with increased criminal activity and domestic violence and an increased rate of significant mental and physical disorders.

[2] Chronic heart failure occurs when the heart is unable to cope with the demands on it and does not pump blood with normal efficiency to the other organs such as the brain, liver and kidneys.

[3] Drummond, D. C., Oyefeso, N., Phillips, T., et al. (2005) Alcohol Needs Assessment

Research Project: The 2004 National Alcohol Needs Assessment for England. Department

of Health, London.

[4] McManus, S., Meltzer, H., Brugha, T., et al. (2009) Adult psychiatric morbidity in

England, 2007: Results of a household survey NHS Information Centre for Health and

Social care, Leeds

[5] Rogers, P. (2007) Rogers Review: National enforcement priorities

for local authority regulatory services, London, The Stationery Office.

[6] National Heart Failure Audit 2010, run jointly by the NHS Information Centre and the British Society for Heart Failure, and commissioned by the Healthcare Quality Improvement Partnership (HQIP).

[7] The consultation version (June 2010) of the guideline was used to produce this draft quality standard, which is referred to as draft clinical guideline on alcohol dependence in the text.

This page was last updated: 18 January 2011

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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.