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NICE approves trials of QOF indicators for PAD and asthma

By Lilian Anekwe

Indicators for peripheral arterial disease will be developed with a view to including them in the quality and outcomes framework, the independent committee appointed by NICE to approve new indicators has decided.

The NICE QOF advisory committee decided at its first public meeting held in Manchester this week to recommend PAD indicators are developed, and if the indicators are approved, to trial PAD indicators in the QOF for the first time.

The committee also decided to approve the development of new indicators for asthma, but rejected submissions demanding new indicators for osteoporosis, chronic kidney disease, diabetes and the prevention of falls in older people. These may be revisited in future.

Professors Helen Lester and Stephen Campbell, from the National Primary Care Research and Development Centre at the University of Manchester, will now develop the indicators which could thenl be piloted over the next six months in 30 practices, before being reviewed at the Committee's June meeting.

Three potential indicators will be developed – an indicator for establishing a disease register for all patients identified and diagnosed with peripheral arterial disease either symptomatically or by ankle brachial pressure index, or extending an existing register in at-risk patients with CHD or stroke, or controversially, for establishing a composite register for all patients with a cardiovascular disease.

Professor Lester said: ‘We would be very strongly in favour of a separate register for PAD rather than a composite on which would be very difficult technically. There's always overlap in the QOF, it shouldn't unduly concern us.'

NICE estimates that 20% of patients aged 55-75 show some signs of PAD but only 5% of those will actually have it. The prevalence of PAD in the general population is 1.1%.

The committee also approved the development of an indicator to reward GPs that give information and education to patients with asthma, after seeing evidence from Northern Ireland, where it is offered as DES, that it could function as the kind of outcome measure NICE has been asked to introduce in the QOF.

Dr Colin Hunter, chair of the committee and a GP in Aberdeen said: ‘We keep being asked about outcomes but outcomes for asthma – other than death – are quite hard to show. The evidence from Northern Ireland that outcomes, including reduction in admissions to secondary care and A&E.'

However, Dr Hunter said they group felt ‘uncomfortable' about the evidence for drawing up potential indicators for osteoporosis at this stage.

‘The committee are uncomfortable that this is largely based on a technology appraisal of a single agent and only assessed for use in women. We also have some discomfort around the issue of resources for what in effect would be a screening programme. The DES will also show outputs in the next year. We will await the output of the DES and more good quality data.'

Health minister Ann Keen announced in November the osteoporosis DES would be extended for a further two years, until 2011, but GP experts attacked the decision as a ‘joke', and said the agreement forced GPs take on large amounts of work for little financial return.

Dr Colin Hunter, chair of the QOF committee at NICE

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