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Add osteoarthritis to QOF to tackle variations in care, researchers urge

A study showing wide variation in osteoarthritis care in general practice has prompted calls for the condition to be one of those NICE adds to the QOF.

An audit of 18 practices in England found substantial differences in the recorded achievement of several ‘quality indicators' chosen by the researchers.

Indicators included the proportion of patients offered self-management education, the proportion offered a referral when pharmacological management failed and how often those treated with an NSAID were asked about gastrointenstinal symptoms in the past year.

Records from 320 randomly selected patients showed a range of 5% to 90% achievement on the four treatment indicators.

There was also considerable variation in other indicators, such as regular assessment of pain and functionality, the study in the December issue of the British Journal of General Practice found.

Study leader Dr Nicholas Steel, senior lecturer in primary care at the University of East Anglia and a former GP, admitted the research could not show to what extent the variation was due to differences in actual care or differences in recording.

But he said: ‘I'm sure the extent of recording is an element but if you look at other sources you get variation – I think the broad pattern is reflecting what's going on. Osteoarthritis isn't in the QOF so that's one possible explanation and personally I think it should be.'

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire, said she was not surprised to see disparities in care as the indicators measured would not necessarily be well known among GPs. ‘There would be a need to educate GPs about osteoarthritis care first, before re-measuring these indicators,' she said.

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