Helping GPs make decisions with the best available evidence

This new quality standard will help doctors to identify the hidden cases of familial hypercholesterolemia

NICE quality standards aim to drive measurable improvements within particular areas of health and care. Each quality standard consists of a concise set of prioritised statements that aim to help GPs, commissioners and other health and social care workers make decisions based on the latest evidence and best practice.

In 2013/14, we produced 28 quality standards on a range of areas that include:

Lower urinary tract symptoms in men was also among the topics covered this year The quality standard highlights the need for greater awareness of the initial assessment and management of the condition, and aims to help GPs and other healthcare professionals ensure men with LUTS get the best quality of care.

In August 2013, NICE published a quality standard on familial hypercholesterolemia (FH) to help GPs identify more cases of what has been dubbed a ‘silent killer’.

FH is an inherited condition caused by an alteration in a gene which results in a high cholesterol concentration in the blood. This can lead to the early development of atherosclerosis and coronary heart disease.

The condition affects 1 in 500 of the UK population, which means that approximately 120,000 people are expected to be affected.

However, it is estimated that more than 80 per cent of cases of FH in the UK go undiagnosed.

The quality standard calls for all adults with a total cholesterol above 7.5 mmol/l to be assessed for the clinical diagnosis of FH. This will result in greater identification of FH and support cascade testing of their relatives.

Cascade testing is important as half of all people with FH will have a first degree relative that will be similarly affected but are often unaware that they have the condition.

An audit of nearly 2,500 patients conducted by the Royal College of Physicians in 2011 found that very few relations were being screened in the UK, especially in England.

The quality standard recommends that people with a clinical diagnosis of FH are offered DNA testing as part of a specialist assessment. This increases the certainty of a diagnosis of FH and allows the identification of affected and unaffected relatives through cascade testing.

Dr Rubin Minhas, Chair of the group that developed the FH quality standard and Group Medical and Scientific Director at Nuffield Health, said: “This new quality standard will help doctors to identify the hidden cases of FH. While a number of audits have shown that diagnosis rates are low for this condition, there is a lack of family cascade testing within families of known FH cases.

“Identifying patients with FH is crucial to ensuring that they can receive early treatment and lifestyle changes which can help to lower the risk of heart disease and improve life expectancy."

Quality standard on ADHD receives strong support

In August 2013, NICE published a quality standard on attention deficit hyperactivity disorder.

The quality standard advises against using drugs as a first-line treatment for children and young people with moderate attention deficit hyperactivity disorder (ADHD), though figures suggest the number of drugs prescribed for this condition have risen sharply in recent years.

The quality standard calls for people with ADHD who are taking drug treatment to be given a specialist review at least annually to assess their need for continued treatment.

NICE says that people taking the drugs need to be monitored regularly due to the number of side effects associated with drug treatment for ADHD, which can also have the effect of reducing adherence to treatment.

Furthermore, without regular monitoring there is a greater risk that drugs prescribed to treat ADHD will be misused.

The quality standard also states that children and young people with moderate ADHD are offered a referral to a psychological group treatment programme.

NICE says such programmes can improve daily functioning and relationships with family members, carers and peers.

Dr Matt Hoghton, Medical Lead for the Clinical and Innovation Research Centre of the Royal College of GPs, said: "The new NICE quality standard for ADHD in children and adults is an important development in ensuring consistent high quality coordinated care with appropriate prescribing.

"Statement 7 specifically identifies the need for a yearly specialist review for people with ADHD, who are taking drug treatment."

He added: "The seven quality statements will help give patients, their families, GPs and commissioners clear standards for this high priority area and ensure that safe systems are in place. I strongly support this NICE standard."