QOF could make NHS Health Checks value for money, say researchers

Current QOF indicators may boost the numbers of patients treated to reduce their risk of cardiovascular disease and make the NHS Health Check scheme better value for money, researchers have said.

BP: QOF could help improve value for money from health checks
BP: QOF could help improve value for money from health checks

Their research found GPs treat two-thirds of patients at risk of cardiovascular disease in line with national standards. But they said opportunities to prevent further cases of the disease are still being missed.

New QOF indicators introduced in April 2013 could help to boost the numbers of at-risk patients treated in accordance with NICE guidelines, they said. This would also make the NHS Health Check programme, which screens patients for vascular risk factors, better value for money.

The study, published in the British Journal of General Practice, looked at how well GP practices adhered to NICE guidelines on reducing cardiovascular disease risk.

A recent Cochrane review cast doubt on the benefits of general health checks for cutting cardiovascular morbidity and total mortality. However, patients identified as at risk must be treated to national guidelines for screening to be worthwhile, and there are no studies examining this, they said.

In the study, a team of UK researchers analysed data from 34,975 patients aged 40-74 at 19 general practices in the UK between 2008 and 2009.

They looked at whether patients had received a formal vascular risk assessment, such as through the NHS Health Check scheme. If not, they calculated 10-year risk using risk factors from patient records, such as smoking status and BP, and the Framingham risk equation.

At the time, the Framingham calculator was recommended by NICE, although this has since been superseded by the QRISK2 tool.

'Room for improvement'

A total of 35% of patients had received a formal risk assessment or their 10-year cardiovascular disease risk could be calculated by researchers. A further 7% had existing cardiovascular disease and risk of secondary cardiovascular disease was known or calculated. The remaining 57% had an unknown risk of cardiovascular disease and would be eligible for screening.

Researchers found 64% of at-risk patients without cardiovascular disease received optimal treatment according to the NICE guidelines at the time. Treatment was prescribed in 80% of those needing statin therapy and 86% of those requiring antihypertensive medication.

However, in patients with cardiovascular disease, only 47% were treated to NICE guidelines. In total, 74% received statin treatment and 95% received antihypertensive treatment.

Researchers said the findings suggested past QOF measures to review patients at risk of cardiovascular disease had not led to treatment in some cases.

But QOF targets introduced in April 2013 targeting stricter BP control and greater use of statins may help to prevent more cases of cardiovascular disease, they added.

Better use of data on risk factors noted in patient records and improved adherence to national guidelines could improve the cost effectiveness of the NHS Health Check programme and deliver the benefits predicted by the DH in 2008, researchers said.

‘However, there is still room for improvement in cardiovascular disease prevention, particularly in patients with existing cardiovascular disease, known or calculable risk,’ they wrote.

‘The inclusion of new cardiovascular disease indicators in the QOF could lead to optimisation of treatment in these at-risk patients but only if such treatment is accepted by patients and their GPs.’

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