'Toughen QOF targets to prevent CHD'

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

The call follows UK research that showed 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.

The 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 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 that will take some time to be seen,’ he said.

Since the study was carried out, CHD carries fewer clinical points. But GPs are still given 89 points, worth £11,089 to the average practice, for secondary prevention of CHD.

Of these points, 17 are for lowering total cholesterol to 5 mmol/l.

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

‘There is a fair bit of debate between NICE and the Joint British Societies (JBS2) 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.

The study was published in the Journal of General Internal Medicine.


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