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QOF depression screening tools 'next to useless'

Use of two questions criticised amid growing disquiet on QOF indicators

The depression screening tools employed in the quality and outcomes framework are little better than useless, a new systematic review concludes.

As many as 62 per cent of

patients identified as depressed by two-item screening tests will actually not be, the damning analysis found.

The research will come as an embarrassment to negotiators since it undermines the evidence for screening patients with heart disease and diabetes as part of the QOF. It comes amid growing disquiet among GPs over the depression screening indicators (see below).

Researchers warned ultra-short screening tests 'appear to be, at best, a method for ruling out a diagnosis', and urged GPs not to rely on screening to establish a diagnosis.

Two-item questionnaires not only play a central role in the QOF but are also recommended by NICE as one method of identifying patients with depression.

But study leader Dr Alex Mitchell, consultant in psychiatry at Leicester General Hospital, told Pulse: 'Recommending these tools on their own is scientifically poor. The bottom line is they can be used but GPs have to bear in mind the accuracy works in one direction – it's a rule-out test.

'They're only step one. The problem with that is most GPs aren't willing or able to use the longer instrument.'

The meta-analysis of 22 trials of ultra-short tests found two- and three-item tests for depression had a positive predictive value of only 38 per cent. The sensitivity of the tests was only 74 per cent and specificity 75 per cent, the researchers report in February's British Journal of General Practice.

Professor Roslyn Corney, professor of psychology at the University of Greenwich, said it would be 'concerning' if a diagnosis was made on the basis of one or two questions. 'GPs also need to use their own interviewing – it can't be just the questionnaire,' she insisted.

The study concluded two-item questionnaires should

only be used 'where there are sufficient resources for second-stage assessment of those who screen positive'.

But GPs warned this would even further increase workload, and that they were already losing faith in the screening indicators. Dr Ian Millington, secretary of Morgannwg LMC, said: 'Depression was included in a way it shouldn't have been.'

The GPC said there remained the capacity to alter the QOF if changes to evidence occurred.

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