Guidelines: Diagnosis, assessment, and management of harmful drinking and alcohol dependence: Summary of NICE guidance

Centre for Outcomes Research and Effectiveness, University College London, London WC1E 7HB, UK.
BMJ (online) (Impact Factor: 17.45). 02/2011; 342(feb23 1):d700. DOI: 10.1136/bmj.d700
Source: PubMed
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    • "The present study adds to previous knowledge by indicating various explanations, as perceived by the GPs, of why a " window of opportunity " after an alcohol-related admission is missed. We demonstrate deficient communication to the effect that patients without a previously unrecognised alcohol problem may remain unnoticed by the GP after hospital admission, thus often preventing the patient from receiving adequate health care from his or her GP after discharge from the hospital [25]. The participants in our study viewed implementation of guidelines for diagnosis, assessment, and management of harmful drinking and alcohol dependence as hampered as a result of fragmented pathways of care. "
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    ABSTRACT: Aims: To explore general practitioners' (GPs') follow-up experiences with patients discharged from hospital after admittance for alcohol-related somatic conditions. Design and participants: Two focus groups with GPs (four women and 10 men), calling for stories about whether the intervention given in the hospital had been recognised by the GP and how this knowledge affected their follow up of the patient's alcohol problem. Systematic text condensation was applied for analysis. Findings: A majority of the GPs had experienced patients with already recognised alcohol problems being rediscovered by the hospital staff. Still, they presented examples of how seeing the patient in a different context might present new opportunities. Few participants had received adequate information from the hospital about their patient's alcohol status, and they emphasised that a report about what had happened and what was planned was needed for follow up. Care pathways for patients with alcohol problems were seen as fragmented. Yet they described how alcohol-related hospital admissions might function as an eye-opener for the patient and a window of opportunity for lifestyle change. Conclusions: Hospital admittances provide important opportunities for change, but hospital care is seen as fragmented and poorly communicated to the GPs. For shared responsibility and follow up, all participating agents, including the patient, must be sufficiently informed about what has happened and what will follow. For the patient, hospital admittance is usually brief, while the relationship with their GP is long term, even lifelong. GPs are therefore key partners for programme development.
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    ABSTRACT: It has been established that alcohol consumption is associated with elevated cancer incidence and mortality. Recently the International Agency for Cancer Research (World Health Organization) stated that acetaldehyde associated with alcoholic beverages is carcinogenic to humans and confirmed the Group 1 classification of alcohol consumption and of ethanol in alcoholic beverages. Alcohol causes cancers of the oral cavity, pharynx, larynx, oesophagus, colorectum, liver and female breast. Very little is known about safe margins of alcohol consumption. There is a dose-response relationship between alcohol and cancer risk for men and women, with studies showing that the risk of cancer increases with increasing consumption of alcohol on a regular basis.
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