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GPs go forth

CVD depression screening set to stay in QOF despite new evidence

Depression screening in patients with cardiovascular disease looks set to remain in the QOF when NICE conducts its cost-effectiveness review, despite new evidence suggesting the indicator has little benefit for patients.

A systematic review of 11 studies by UK researchers raised questions over whether depression screening in patients with cardiovascular disease was worthwhile, adding to pressure to remove it from the contract.

A Cochrane review published earlier this year also found no justification for the use of depression screening questionnaires in primary care.

The new study, published in the latest issue of JAMA, found about a third of patients with CVD would ‘screen positive' for depression but only about 40% of those would have major depression.

And the researchers found no evidence that depression treatment improved cardiac outcomes – a justification used for inclusion of the screening indicator.

Study author Dr Alex Mitchell, consultant in psychiatry at Leicester General Hospital, said more research was needed into the effects of screening in these patients.

‘Good quality studies haven't been done. But where it falls down is not so much the detection, it's what to do next.'

But Mr Stephen Pilling, consultant clinical psychologist at UCL and a member of the NICE panel currently finalising guidance on depression in patients with chronic health problems, insisted screening was worthwhile.

‘Depression in people with comorbidities is significant enough of an issue to support it being included in guidance', he added.

Dr Terry McCormack, ex-chair of the Primary Care Cardiovascular Society, said the study had confirmed many GPs feeling on depression screening.

‘I fear it is one of the weakest QOF requirements, not least because people treat it as a tick box exercise and don't do it with any conviction.'

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