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At the heart of general practice since 1960

QOF 'may not have improved diabetes care'

By Nigel Praities

GP management of diabetes has improved over the past decade, but this may not be a direct result of QOF, says a major study.

The framework may even lead to reduced levels of care for some patients, concluded researchers from the University of Birmingham and University College London looking at diabetes management in primary care from 2001 to 2007.

Their research – published online by the British Medical Journal – found the introduction of the QOF was associated with an increased rate of patients with HbA1c levels of 7.5 or less.

But they also found the overall rate of improvement in glycaemic control, cholesterol levels and blood pressure in patients with diabetes was ‘attenuated' after the introduction of the QOF in 2004.

‘The management of people with diabetes in the UK has improved since the late 1990s. The relation between incentives and attainment of targets may not, however, be as straightforward as initial reports suggest.

‘Pay for performance may have contributed to the improvement in diabetes care but the relative importance of the quality and outcomes framework to other national quality improvement strategies is unclear,' the paper says.

The researchers also criticised the QOF for ‘selective inclusion' of patients and exclusion of patients through exception reporting.

‘The scheme in its present form fails to capture almost one third of people

in whom care may be suboptimal and may even lead to reduced levels of care for some groups of patients,' the paper concludes.

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