Wednesday, June 2, 2010

qotd: AHIP mischaracterizes NICE alcohol screening recommendations

America's Health Insurance Plans (AHIP)
June 2, 2010
British Doctors Must Now Ask: Tell Us How Much You Drink
(Source - Rebecca Smith, The Daily Telegraph)

Under new guidelines set by the National Institute for Health and Clinical Excellence (NICE), British healthcare providers are required to inquire about their patients' drinking habits as a means to curb the nation's problem with drinking. NICE recommends that doctors and pharmacists alike gauge patient-consumption tendencies through a series of "alcohol screening" questions - the line of interrogation including no less than 10 questions.


National Institute for Health and Clinical Excellence (NICE)
PH24 Alcohol use disorders: preventing harmful drinking: guidance

Recommendation 9: screening adults

Where screening everyone is not feasible or practicable, NHS professionals should focus on groups that may be at an increased risk of harm from alcohol and those with an alcohol-related condition. This includes people:

− with relevant physical conditions (such as hypertension and gastrointestinal or liver disorders)
− with relevant mental health problems (such as anxiety, depression or other mood disorders)
− who have been assaulted
− at risk of self-harm
− who regularly experience accidents or minor traumas
− who regularly attend GUM clinics or repeatedly seek emergency contraception.

Full report (100 pages):

The 10 questions used for screening (page 16 of 35 pages):

About NICE: "NICE produces guidance on public health, health technologies and clinical practice."

Comment:  Great Britain's National Institute for Health and Clinical Excellence (NICE) produces guidance on public health, health technologies and clinical practice. Their efforts are directed at improving value in health care, especially reducing spending for ineffective or inappropriate services and products.

America's Health Insurance Plans (AHIP) has repeatedly called for government policies that would help control spending. You would think that AHIP would be supportive of the NICE concept, but by distributing today's release that falsely states, in essence, that British physicians are being required to invade the privacy of every one of their patients by submitting them to a questionnaire on alcohol use, it seems that AHIP is joining forces with the conservatives who have been condemning NICE as a program of socialistic government rationing. Nowhere in the 100 page NICE report does it state that universal alcohol screening is an absolute requirement. Also for a physician to discuss alcohol problems with a patient is no more an invasion of privacy than discussing any other factors that might influence the patient's health.

The good news is that the United States has taken a step forward by expanding the role of comparative effectiveness research (CER). Although it is unclear as to whether CER would have much impact on total health care spending, there is no question but that it will provide greater value in our health care.

If we really do care about attaining greater value then we need to expand NICE-like policies while eliminating the profound waste of the superfluous insurance industry represented by AHIP.

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