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GPs manipulated blood pressure readings for QOF, research claims

By Lilian Anekwe

Reductions in blood pressure after introduction of the QOF were ‘exaggerated' by GPs manipulating recordings to hit targets, researchers are claiming.

Their study of blood pressure recording bias found measurements started to cluster just below the 150/90mmHg target after the QOF came in.

In 2004/5, patients were three times more likely to have a reading of 148-149mmHg than 151-152mmHg, whereas in 2000/1, there was little difference in the frequency of the two sets of readings.

There was also a trend of recordings just below 90mmHg occurring increasingly more frequently after 2004.

Researchers said the most likely explanation was that GPs were deliberately showing recording bias, ‘by which patients with blood pressure just above 150 mmHg have it recorded just below'.

The study, published online in the Journal of Human Hypertension, analysed blood pressure recordings from patients with cardiovascular disease from 152 practices between 2000 and 2005.

Study leader Dr Iain Carey, research fellow in community health sciences at St George's University of London, told Pulse: ‘Post QOF, there was an excess of values recorded just below the QOF target. We should not be surprised that the QOF resulted in recording bias.'

Dr Christopher Clark, a GP in Tiverton, Devon, and a member of the British Hypertension Society, said the study raised both clinical and ethical concerns.

‘The most important finding is the huge amount of zero-digit preference. This suggests this is a widespread systematic recording bias rather than evidence for widespread fraudulent practice.

'This study makes a case for promoting education and training in accurate BP measurement and recording.'

GPs accused of manipulating blood pressure readings to gain QOF points

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