intelligent commissioning in alcohol services beyond the units… bradford airedale craven &...
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Intelligent Commissioning in Alcohol Services Beyond the Units…Bradford Airedale Craven &
Wharfedale Alcohol Project – BACWAP
"Data! Data! Data!” he cried impatiently
"I can't make bricks without clay."
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Declaration of Interests 2013/14
Current roles and affiliations Lead Partner Bradford Student
Health Service – Bradford City CCG
Bradford & Aidedale Clinical Specialities Commissioning Lead Drugs & Alcohol (Airedale Wharfedale & Craven CCG, Bradford Districts CCG, Bradford Districts CCG, Bradford City CCG
Specialist GP Drugs & Alcohol Bradford District Care Trust
Honoraria Lundbeck – ‘Consensus on Commissioning Principles for Alcohol Related Harm’
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CCGs’ Priority – reduction in Alcohol related admissions
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ALCOHOL FCEs100% alcohol attributable
Appendix A: Alcohol-attributable chronic and acute conditions and finished care episodes in England for 2012/13 Table 1: Chronic conditions: 100% attributable
Description ICD-10 code(s) Attributable fraction FCEs
Males Females Males Females
Alcoholic liver disease K70 1.00 1.00 22,212 11,308
Chronic pancreatitis (alcohol induced) K86.0 1.00 1.00 2,142 622
Alcoholic gastritis K29.2 1.00 1.00 1,752 747
Degeneration of nervous system due to alcohol G31.2 1.00 1.00 451 177
Alcoholic cardiomyopathy I42.6 1.00 1.00 267 31
Alcoholic myopathy G72.1 1.00 1.00 23 8
Alcohol-induced pseudo-cushing’s syndrome E24.4 1.00 1.00 1 0
Alcoholic polyneuropathy G62.1 1.00 1.00 - -
Table 2: Acute conditions: 100% attributable
Description ICD-10 code(s) Attributable fraction FCEs
Males Females Males Females
Ethanol poisoning T51.0 1.00 1.00 608 469
Toxic effect of alcohol, unspecified T51.9 1.00 1.00 71 66
Methanol poisoning T51.1 1.00 1.00 25 13
Accidental poisoning by and exposure to alcohol X45 1.00 1.00 - -
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ALCOHOL FCEsA bigger problem:<100% attributable-Chronic
Appendix A: Alcohol-attributable chronic and acute conditions and finished care episodes in England for 2012/13
Table 3: Chronic conditions: less than 100% attributable
Description ICD-10 code(s) Attributable fraction FCEs
Males Females Males Females
Oesophageal varices I85 0.73 0.46 7,586 4,217
Liver cirrhosis K73, K74 0.72 0.47 4,288 3,865
Epilepsy and status epilepticus G40, G41 0.55 0.50 31,619 27,595
Gastro-oesophageal laceration-haemorrhage syndrome K22.6 0.47 0.47 2,374 1,436
Malignant neoplasm of lip, oral cavity and pharynx C00-C04 0.45 0.26 16,998 6,778
Psoriasis L40, excl L40.5 0.34 0.24 6,581 6,734
Cardiac arrhythmias I47-I48 0.31 0.23 87,351 74,031
Malignant neoplasm of larynx C32 0.28 0.14 4,518 952
Malignant neoplasm of oesophagus C15 0.26 0.12 26,195 10,847
Hypertensive diseases I10-I15 0.25 0.10 7,444 8,541
Acute and chronic pancreatitis K85, K86.1 0.22 0.09 23,147 18,397
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ALCOHOL FCEsA bigger problem:<100% attributable Acute
Table 4: Acute conditions: less than 100% attributable
Description ICD-10 code(s) Attributable fraction FCEs
Males Females Males Females
Fire injuries X00-X09 0.38 0.38 - -
Pedestrian traffic accidents V02-V04 (.1-.9), V06.1, V09.2, V09.3 0.36 0.18 - -
Drowning W65-W74 0.34 0.34 - -
Intentional self-harm/event of undetermined intent X60-X84, Y10-Y34 0.34 0.31 - -
Road traffic accidents (driver/rider)
V12-V14 (.3-.9), V19.4-V19.6, V19.9, V20-V28 (.3-.9), V29-V79 (.4-.9), V80.3-V80.5, V81.1, V82.1, V82.9, V83-V86 (.0-.3), V87.0-V87.9,
V89.2, V89.3, V89.9
0.32 0.11 - -
Assault X85-Y09 0.27 0.27 - -
Inhalation of gastric contents/inhalation of food causing obstruction of respiratory tract
W78-W79 0.25 0.25 - -
Accidental excessive cold X31 0.25 0.25 - -
Firearm injuries W32-W34 0.25 0.00 - -
Spontaneous abortion O03 - 0.21 - 39,887
Water transport accidents V90-V94 0.20 0.00 - -
Air/space transport accidents V95-V97 0.16 0.16 - -
Fall injuries W00-W19 0.15 0.05 - -
Work/machine injuries W24-W31 0.07 0.07 - -
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The Treatment Gap
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• SHA stated objective was ‘Industrialising’ Alcohol Screening in Primary Care.
• An ad hoc approach in the context of a routine consultation is more cottage industry.
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Radically Obvious Principles of Intelligent Alcohol CommissioningIf we know alcohol abuse is
associated with so much morbidity then commissioning just for ‘less drinking’ is:
silo thinkingblinkered vision‘hit & hope’
‘We’ll hit the problem … and keep our
fingers crossed that all those associated
conditions get better…’
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Really Intelligent Commissioning in Alcohol Services
Integrated Care /Service delivery interface
Addressing 100% and < 100% and even non-causal physical morbidity
Dual Diagnosis District-Wide Register
Alcohol is the most commonly misused drug in patients with SMI
SAFEGUARDING – Adult & ChildDon’t just commission for fewer units!
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Where is the patient in all of this?
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‘Data Data Data…’