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News – September 2011

Contents

Advice published on improving care for alcohol-related disorders

NICE has published two pieces of guidance, with the aim of improving provision of high-quality care for people with alcohol-related conditions:

  1. A commissioning guide to support the design of high-quality services that improve the identification and treatment of hazardous drinking, harmful drinking, and alcohol dependence in people of all ages.
  2. A quality standard for alcohol dependence and harmful alcohol use.

Commissioning guide
The guide covers:

  • opportunistic screening and brief interventions
  • specialist services for diagnosis, assessment, and management of harmful drinking and alcohol dependence in adults
  • services for children and young people who are vulnerable to alcohol- related harm
  • whole-system commissioning of high-quality alcohol services.

Quality standard
The quality standard on alcohol misuse consists of 13 statements that cover various aspects of care, such as:

  • offering medically assisted alcohol withdrawal if needed
  • providing treatment in the most appropriate setting
  • identifying the needs of families and carers of people who misuse alcohol
  • using regular treatment outcome reviews to plan subsequent care for people who are receiving specialist treatment for alcohol misuse.

www.nice.org.uk

Patient guide to GP services compiled by RCGP

The Royal College of General Practitioners (RCGP) has released It's your practice: a patient guide to GP services. This 'one-stop-shop' guide aims to develop stronger relationships between doctors and patients and to encourage patient involvement in their own care. It is a resource that provides patients with information on:

  • finding and choosing a practice
  • how to get the most out of a GP consultation
  • accessing health records
  • understanding patients' rights and responsibilities
  • the differences in GP services across the four nations.

The patient guide is available free of charge from both the RCGP and NHS Choices wesbites.

www.rcgp.org.uk

NICE releases guidance on the management of hypertension

Hypertension is a major risk factor for stroke, myocardial infarction, heart failure, chronic kidney disease, and premature death. At least one quarter of the adult population in the UK has hypertension, which if left untreated can lead to a progressive rise in blood pressure resulting in a treatment-resistant state due to the associated vascular and renal damage.

NICE has released Clinical Guideline 127, Hypertension: clinical management of primary hypertension in adults, which updates and replaces Clinical Guideline 34. The updated guideline includes new recommendations alongside old and amended recommendations from the previous guideline.

New recommendations have been made in the following areas:

  • measuring blood pressure
  • diagnosing hypertension
  • initiating treatment
  • monitoring treatment and blood pressure targets
  • choosing antihypertensive drug therapies.

Key priorities for implementation include:

  • offering patients aged 80 years or older the same treatment as those aged 55–80 years, taking into account any co-morbidities
  • offering calcium-channel blockers (CCB) for the treatment of hypertension to people aged over 55 years and to black people of African or Caribbean origin of any age. If a CCB is not suitable, a thiazide-like diuretic should be offered instead.

Another important new recommendation in the guideline is that the diagnosis of hypertension should now be made using 24-hour ambulatory blood pressure monitoring (ABPM) instead of diagnosis by a GP using an inflatable arm cuff. Patients with a blood pressure of 140/90 mmHg or higher should be offered ABPM. This is based on new evidence, which suggests that ABPM is a more accurate and cost‑effective way of diagnosing hypertension than both clinic and home monitoring. It is also hoped that allowing people to measure their blood pressure away from their GP clinic will avoid the temporary rise in blood pressure known as the 'white coat effect'.

www.nice.org.uk

15 minutes of exercise a day can increase life expectancy

The Department of Health (DH) currently recommends that all adults and older people over the age of 65 years should participate in 150 minutes of exercise each week. The DH also advises that children and young people up to the age of 18 years receive at least an hour of exercise each day. However, new research, based on a review of over 400,000 people in Taiwan, showed that exercising for 15 minutes a day or 90 minutes a week can have a positive impact on health and life expectancy.

The latest study, published in the Lancet, found that exercising for 15 minutes a day could increase life expectancy by 3 years and cut the risk of all-cause mortality by 14%. The study also found that an additional 15 minutes of daily exercise beyond the initial 15 minutes can further reduce all-cause mortality by 4%.

In Public Health guidance 8, Promoting and creating built or natural environments that encourage and support physical activity, NICE recommends building exercise into people's daily routine and has produced the guidance to enable local authorities to create environments to promote physical activity.

NICE has also published guidance on encouraging employees to be physically active (PH13) and on four commonly used methods to increase physical activity (PH2). The latter encourages GPs to identify inactive adults and advise them to aim for 30 minutes of exercise 5 days a week.

www.nice.org.uk

News in brief - An interim statement on the physical signs of child sexual abuse has been issued by the Royal College of Paediatrics and Child Health and the Royal College of Physicians of London

It should be read alongside the current evidence-based review and guidance for best practice.

www.rcpch.ac.uk/csa

News in brief - The Audit Commission has produced an assessment tool for domestic-abuse services

This web resource will help providers of these services to support mainstream statutory work and review their local partnerships, in addition to helping victims of domestic abuse.

audit-commission.gov.uk

News in brief - NICE has published guidance on the use of golimumab for the treatment of ankylosing spondylitis

Technology Appraisal (TA) 233 recommends golimumab as an option for the treatment of adults with severe, active ankylosing spondylitis in specific circumstances. It should be used as described for adalimumab and etanercept in TA143 and the manufacturer should provide the 100 mg dose of golimumab at the same cost as the 50 mg dose. Those taking golimumab who do not fit the criteria described in TA143 should be able to continue treatment until they and their clinician consider it appropriate to stop.

www.nice.org.uk

News in brief - NICE Technology Appraisal 234 does not recommend abatacept in combination with methotrexate for the treatment of moderate to severe active rheumatoid arthritis

in adults whose disease has responded inadequately to one or more conventional non-biological disease-modifying anti‑rheumatic drugs (DMARDs), including methotrexate. People currently taking abatacept whose disease has responded inadequately to one or more conventional non-biological DMARDs, including methotrexate should have the option to continue treatment until they and their clinician consider it appropriate to stop.

www.nice.org.uk

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