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Older people with conditions not in QOF getting worse care

By Lilian Anekwe

The quality of care for older patients is substantially poorer for conditions that are not incentivised by the Quality and Outcomes Framework, a new analysis reveals.

Primary care academics have claimed unincentivised medical conditions associated with older age – including osteoarthritis and osteoporosis – are being crowded out by conditions for which GPs are paid financial rewards.

Overall, 75% of people received the right treatment for conditions in the QOF, but only 58% of people were given the correct treatment for non-QOF conditions.

For example, the treatment of 83% of patients with ischaemic heart disease was deemed to be appropriate by an independent medical panel, but just 29% of recommended care was given to patients with osteoarthritis.

Similarly, osteoporosis (53%), urinary incontinence (51%) and falls management (44%) scored lower for quality of care. A higher quality of care was provided for general medical conditions (74%) than geriatric conditions (57%), including referral for cataracts and hearing problems.

The study of 8,688 people aged 50 and over assessed the quality of care of 13 different conditions using a composite measure based on 32 clinical and seven ‘patient centred' quality indicators in 2005.

The researchers, who publish their study in the BMJ today, concluded the standard of care for people aged over 50 with conditions associated with older age is poor, and urged the inclusion of more geriatric conditions in future versions of the GP contract.

Dr Nick Steele, lead researcher and senior lecturer in primary care at the University of East Anglia told Pulse: ‘The quality of care of conditions associated with older age has suffered while other public health conditions have gotten a higher profile.

‘It may be that for incentivised conditions GPs operate almost on auto-pilot and are much more used to delivering the correct care.

‘Whilst other conditions, that aren't in the QOF, get neglected and are not so much a part of medical training – patients are much more reliant on an individual GP's knowledge and ability.'

In an accompanying editorial, Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee, wrote: ‘The quality of health care for older adults has important deficiencies.

‘This applies particularly to "geriatric" conditions that cause high morbidity, like deafness and osteoarthritis, and that are currently excluded from routine measurement and incentivisation.

‘This finding reinforces evidence that performance management of particular measures risks creating tunnel vision and crowding out improvement work for other care.'

Older people receive a poorer standard of care Older people receive a poorer standard of care

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