GPC backs QOF as study questions outcomes targets

The GPC moved to defend the QOF after an international study claimed incentivised targets for BP management have had no impact on patient outcomes.

Research published in the BMJ suggested QOF indicators to manage patients’ BP have made ‘no discernable difference’ to improving care and patient outcomes.

GPC chairman Dr Laurence Buckman said the QOF was more than just an incentive scheme and supported previously unfunded work to reduce health inequalities.

The 2010/11 QOF awards a total of 165 points for indicators relating to BP recording and management, or about one in six QOF points. These range from holding a record of patients with hypertension to lowering BP in patients with diabetes.

In the study, researchers examined primary care records from 358 UK general practices, including 470,725 patients diagnosed with hypertension between January 2000 and August 2007.

The team examined the effect of BP monitoring, control and treatment intensity on patients’ BP outcomes and illnesses over this time: three years before the introduction of QOF and four years after.

But analysis showed no change in any of these measurements that could be specifically attributed to QOF targets.

QOF had no impact on medication prescribing, nor was there any identifiable impact on stroke, MI, renal failure, HF, or mortality.

Researchers concluded: ‘The programme’s lack of effect may be explained in part by performance targets that were set too close to existing practice.’

They added: ‘To stimulate further improvement in hypertension care in the UK, it may be necessary to implement other evidence based interventions on a large scale.’

Dr Buckman responded: ‘The QOF is still relatively new. Other studies have shown that it has improved care and treatment for people with diabetes and reduced the number of heart attacks and deaths, particularly in deprived areas. We expect the true gains will be seen in the long term as more evidence becomes available.’

He added: ‘It is also thanks to the QOF that we now have a wealth of public health data, meaning we know more than ever before about the prevalence of disease in this country, and we have a method of delivering evidence-based care to improve it.’

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