News January 2002
- NICE launches referral guide for common conditions
- Guidelines on angina updated
- News in brief: Aids to discussing mental health issues with patients
- Meningitis C vaccination extended to 20-24 year olds
- Enter our Awards and you could win up to £3000 for your team
NICE has published referral criteria to help clinicians decide how urgently patients with certain common conditions need to be referred.
The booklet Referral Advice has been designed as a tool for developing local referral guidelines rather than formal NICE guidance.
The guide covers acne; acute low back pain; atopic eczema in children; menorrhagia; osteoarthritis of the hip and knee; glue ear; psoriasis; recurrent episodes of acute sore throat in children under 15; prostatism; and varicose veins.
The clinical criteria for referral for each condition are set out as consensus statements based on the best available evidence. These are summarised on p.76 of this issue and will also appear in subsequent issues. Further details on referring patients with acne can be found on p.74.
The 11 conditions were selected because there was uncertainty about which patients might benefit from specialist services, which could lead to variations in care.
"As well as enabling appropriate commissioning arrangements to be made locally, the referral advice is a brief and simple aide-mžmoire for GPs on the current, evidence-supported approach to these topics," commented Salisbury GP Dr Charles Sears.
"It is quick and easy to digest, and I feel it would be of value to every GP," he added.
"The NICE referral advice provides brief, concise and up-to-date guidance on current best practice. Its use should reduce the volume but increase the quality of referrals onward from primary care. It will also be useful to share with patients in the management of their problems," Sheffield GP Dr Chris Barclay told Guidelines in Practice.
The advice was produced by a series of advisory groups with input from patients and GPs as well as members of other disciplines. The guide also contains sections on implementation and audit.
"We hope that the booklet will act as a useful resource to stimulate specialists and GPs to get together to discuss local referral policies," Professor Richard Baker, who helped develop the audit section, told Guidelines in Practice.
"The booklet can be used by individual GPs or PCOs," added Professor Baker, Director of the Clinical Governance R&D Unit, Department of General Practice, University of Leicester.
- Copies of the booklet can be downloaded from the NICE website: www.nice.nhs.uk
- National Institute for Clinical Excellence. Referral Advice: A guide to appropriate referral from general to specialist services. London: NICE, 2001.
The evidence for beta-blockers as first-choice therapy in stable angina patients requiring regular treatment has been strengthened in a revised guideline from the North of England guidelines group.
The recommendation in the 1996 guideline was based on indirect evidence from MI patients, but the revised guideline now includes trial evidence demonstrating that beta-blockers reduce morbidity in patients with stable angina.
Verapamil is still suggested as an alternative in those who cannot tolerate beta-blockers.
Recommendations on assessment and referral are in line with the National Service Framework for Coronary Heart Disease, and have changed little since the original guideline.
There are no specific recommendations on cholesterol-lowering therapy. The guideline advises that treatment of risk factors should be based on a patient's absolute risk of further cardiovascular events and death, taking multifactorial risk into consideration.
"This is accepted primary prevention, but is controversial for patients with known coronary artery disease," comment Drs Tim Lancaster and Michael Moher, Institute of Health Sciences, Oxford, in an editorial in the BMJ.
"Most guidelines treat xisting disease as evidence of high risk. For example, the National Service Framework sets targets for cholesterol reduction in all patients with angina. In the absence of a reliable tool for risk stratification, this seems a more workable approach to secondary prevention," they add.
- Br Med J 2001; 323: 1202
The North of England guidelines group has also revised its guidelines on the primary care management of asthma in adults in the light of new evidence.
- Br Med J 2001; 323: 1380-81
Both guidelines can be found on the website www.bmj.com
The WHO has produced a series of fact sheets on the six most common mental health disorders in primary care. The interactive summary cards are designed for use in the consultation to facilitate discussion between doctor and patient and help devise a management plan. The first in the series, on alcohol, is on p.68 of this issue. Over the coming months we will feature the rest of the series, which covers: anxiety; chronic tiredness; depression; sleep problems; and unexplained somatic symptoms.
The full guidance can be downloaded from www.rsm.ac.uk/pub/bkwho.htm
Young people aged 20 to 24 should be immunised against meningitis C, the DoH announced at the beginning of January. The overall risk of meningococcal infection in this group is more than double the background rate in older adults.
"As we are now entering the peak meningitis season it is important that unimmunised individuals under 25 years of age should be identified where possible and offered vaccine," says a statement from the DoH.
All individuals in this age band who have not been immunised with conjugate Group C vaccine(MenC) in the past should be offered immunisation, according to the Joint Committee on Vaccination and Immunisation. Those who have received the polysaccharide vaccine more than 3 years ago should now be offered MenC vaccine.
"Implementation of the initial meningitis C campaign introduced in 1999 worked well and the campaign proved highly successful. As we approach the peak period for meningococcal disease, surgeries should commence this vaccination programme as soon as possible," commented immunisation nurse specialist Jane Chiodini.
- Immunisation with the new conjugate pneumococcal vaccine
is recommended for children at risk under the age of two years.
High-risk groups include those suffering from: asplenia, severe spleen dysfunction including sickle cell disease and coeliac syndrome; chronic renal disease or nephrotic syndrome; immunodeficiency or immunosuppression including HIV infection; chronic heart, lung or liver disease; and diabetes mellitus.
The vaccine should be given as three single doses at 2, 3 and 4 months of age or as two doses at least a month apart in children aged 5-24 months.
For further information, go to http://www.doh.gov.uk/cmo/cmoh.htm
- DoH 4 January 2002
This year we are launching the Guidelines in Practice annual awards to reward innovative primary and shared care initiatives to implement national clinical guidance.
Entry is open to GPs and other members of the primary healthcare team, members of primary care organisations and other healthcare professionals within the NHS.
For further details and a copy of the pull-out entry form turn to p.39 of the January issue or click here.
The closing date for entries is 31 May 2002.
The winning team will receive £3000 and the two runners-up will each receive £1000.
The winners will be announced in the October issue of the journal.