The primary goal of the NHS Long Term Plan is to reduce health inequalities through improving the health of the population and preventing illness and disease. NHS England places a high priority on reducing health disparities since those living in poverty are disproportionately represented among those with chronic diseases and other forms of ill health. To this end, the NHS Long Term Plan contains many different preventative initiatives, including commitments around supporting patients with alcohol and tobacco dependencies. In this article we look at how primary care has a role to play in the early detection of alcohol dependency and how the EK Health Kiosk may provide crucial support to the busy GP practice in identifying those patients that need help.
The consequences of Alcohol Dependency
Among English citizens aged 15 to 49, alcoholism is the biggest cause of premature death, poor health, and disability. High blood pressure, atrial fibrillation (abnormal heart rhythm), cardiovascular disease, and stroke are just some of the long-term problems linked to alcohol consumption. Long-term alcohol usage is linked to numerous health problems, including liver disease, heart disease, stroke, and cancers of the breast, mouth, and throat.
In 2020, the health gap between the richest and poorest 20% of the population widened as a result of alcohol-related mortality. Because of the stigma attached to mental illness and alcoholism, people who suffer from these conditions are often prevented from receiving the help they need. Deaths from alcohol-related mental and behavioral disorders are thought to have increased by a factor of nearly 10 during the pandemic. The NHS continues to see late presentations through emergency care, which, in addition to the ongoing impact on the individual and their families, creates demand for more specialized - and costly - care provided by the NHS. Some estimates suggest that less than 20% of alcohol-dependent people are accessing treatment services.
In order to screen for problem drinking, NICE recommends the use of the Alcohol Use Disorders Identification Test (AUDIT) to routinely assess the nature and severity of alcohol misuse. A patient's alcohol use can be estimated by asking the scored questions that form the AUDIT, including "How often do you have a drink that contains alcohol?” and “How many standard alcohol units do you consume daily?” AUDIT scores are interpreted as:
0-7 indicates low-risk.
8-15 indicates increasing risk.
16-19 indicates higher risk.
20 or more indicates possible dependence.
Screening for alcohol use disorders should be a standard element of basic care, such as when registering a new patient, performing additional screenings, reviewing medications, or visiting a patient for a prenatal checkup; even treating small injuries can be an indicator,
If screening everyone is not feasible or possible, for your GP practice, focus on people who have an alcohol-related condition or who are at increased risk of harm from alcohol. This includes people:
Having a condition that calls for special attention (such high blood pressure, an upset stomach, or liver trouble).
Having a diagnosable mental health condition (such as depression, anxiety, or bipolar disorder).
Who have been assaulted.
At risk of self-harm.
Who regularly experience accidents or minor traumas.
Who seek emergency contraception or routinely visit a clinic specialising in genitourinary treatment.
Even if they know their drinking puts them at danger, those whose consumption falls short of alcohol dependency but are still drinking at levels above the low risk drinking standards typically do not seek medical attention.
So, how can a busy GP Practice find the time for AUDIT screening?
Given that clinicians only have so much time with each patient to gather vital information and administer preventative care it is difficult to find the time to go through the questions that make up the AUDIT screening tool. Commonly overlooked preventive screens also include social history and behavioural health information. This could be because it is assumed to take more effort and time to evaluate these areas, and because the information they contain is viewed as more delicate.
It takes up valuable time for clinicians to conduct patient interviews, and studies have shown that commonly people are more comfortable sharing personal information in a digital context. So while patients are spending time in waiting rooms prior to an appointment it makes sense to opportunistically gather some of this important information with an EK Health Kiosk which can screen for alcohol use, smoking status and other health information.
The EK Health Kiosk - Your New Team Member
Clinical pathways for use with the kiosk include the full alcohol use disorder identification test (AUDIT) on the kiosk, which includes AUDIT-C functionality – if a user scores under 5 to the first three questions, they can then bypass answering the whole audit. Plus, with the record of alcohol consumption in the preceding 12 months also contributing to ever valuable and revenue generating QOF points, the EK Health Kiosk is a valuable addition to the clinical and administration team.
If you are a healthcare clinician or GP practice manager that would like to see how our self-screening health kiosk works, then we'd be happy to arrange a demo for you - contact us by email on hello@ekinteractive.co.uk or call 01223 812737.
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