Outdated QOF approach 'has had its day', experts warn

The algorithmic approach to diabetes care exemplified by QOF 'has had its day' and is no longer an appropriate way to treat patients, the authors of a new treatment statement say.

Consultation: best diabetes care involves 'thoughtful clinician working with the patient'
Consultation: best diabetes care involves 'thoughtful clinician working with the patient'

This year, a joint statement on type 2 diabetes from the European Association for the Study of Diabetes and the American Diabetes Association called for individualised care.

Speaking at the 2012 meeting of the European Association for the Study of Diabetes in Berlin on Tuesday, the statement's authors said guidelines and algorithms had led to a dogmatic approach to care.

Professor David Matthews of Oxford University said the 'one-size-fits-all' approach used by QOF led to 'a completely inappropriate way of giving therapy', with patients overtreated to meet targets.

'The algorithmic approach has finally, in our view, had its day,' he said. 'We can't do that any more.'

Professor Matthews said the statement was not a guideline and avoided saying 'in any dictatorial way what a clinician must do with each patient'.

He said: 'There is no answer to that explicit question "Tell me exactly what I must do." Up to now we have had guidelines which say you must be one or other side of a certain threshold. That doesn't gel well with what we know.'

He added: 'It is very difficult to make a one-size-fits-all recommendation. The problem with QOF is that there are numbers that say that you'll get paid one side of this point and not the other.'

Professor Silvio Inzucchi of Yale School of Medicine, Connecticut, US said the position statement emphasised the need for thoughtful patient engagement.

'There's a tendency to remove the thought process from clinical care,' he said. 'There's all these "experts" releasing these algorithms and statements and primary care doctors are inundated with these.

'In the end, the best treatment for diabetes is a thoughtful clinician working collaboratively with the patient to achieve the best control that that patient can achieve.'

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