QOF targets 'do not reduce CHD'

Quality framework targets for cholesterol must be lowered further if the framework is to prevent secondary CHD, claim experts.

The call follows UK research that shows current CHD quality indicators have failed to reduce the number of hospital admissions for the disease.

For the study, researchers compared rates of hospital admissions for CHD, coronary angioplasty and coronary artery bypass grafting in England against 2004/5 quality framework scores for all 303 PCTs in England. Researchers adjusted for disease prevalence and socioeconomic deprivation.

Overall, English PCTs performed well on the clinical domain, with an average quality score of 100 out of a possible 101 points for CHD available under the GMS contract at the time.

But no relationship was found to suggest that these high quality scores led to a reduction in hospital admissions for CHD, said lead researcher Dr Robert Bottle, from the department of primary care at Imperial College London.

'This research suggests that better primary care for CHD patients may not prevent many hospital admissions, unless the new GP contract has itself led to significant improvements in care, and that will take some time to be seen,' he said.

Since the study was carried out, CHD carries fewer clinical points. There are still 89 points, worth £11,089 to the average practice, for secondary prevention of CHD. Of these points, 17 are for lowering total cholesterol to 5mmol/l.

Surrey GP Dr John Pittard, a member of the Primary Care Cardiovascular Society (PCCS), said the latest findings furthered the argument that cholesterol targets needed to be tougher.

'There is much debate between NICE and the Joint British Societies about lowering the cholesterol targets from 5mmol/l for total cholesterol and 3mmol/l for LDL cholesterol down to 4mmol/l and 2mmol/l,' he explained.

West London GP Dr Sarah Jarvis, a member of the PCCS, said: 'The quality framework only goes as far as providing the minimal standard of care, instead of optimal care. We should be moving towards targets of 4mmol/l and 2mmol/l.

'If we stick with the current cholesterol targets then we should be thinking about reducing the levels of exception reporting.'

sanjay.tanday@haymarket.com

J Gen Intern Med Online 2007

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