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The waiting game

QOF severity assessment refines antidepressant use

Assessing severity of depression by questionnaire can radically cut GP antidepressant scripts for mild depression, a new study concludes.

The research suggests the controversial depression indicators in the revised quality and outcomes framework may benefit patients by targeting drug use more effectively.

But the study drew a mixed response from GPs, with some remaining sceptical that the apparent improvements justified the extra workload.

Before introduction of depression severity assessment, an evaluation undertaken in Southampton found 40 per cent of antidepressants went to patients with mild illness.

But this proportion fell to just 13 per cent after introduction of assessment with the hospital anxiety and depression scale and guidance on targeting antidepressant use.

'Measuring severity therefore does seem to improve the targeting of GP antidepressants, which is the aim of the quality indicator,' the study concluded.

Professor Tony Kendrick, professor of medicine at the University of Southampton, who conducted the audit, said he be- lieved severity assessment was not as laborious as GPs had feared. 'HAD-D has seven questions while PHQ-9 is only two questions longer,' he said.

Professor Kendrick, who is a GP in Southampton, added: We are using the PHQ-9 in my practice. The patients seem to accept it and are interested to know what their score means. GP colleagues have also said they have found the severity measures useful, despite being a bit sceptical at first.'

His research, published as a letter in October's British Journal of General Practice, assessed antidepressant prescribing at Southampton PCT between December 2005 and April 2006.

Dr Mitch Garsin, LMC chair for Hillingdon, said the results demonstrated the potential usefulness of the indicators: 'It is mildly time-consuming, but I don't think it's that intrusive.'

But Dr Stephen Fox, chair of Wigan LMC, disagreed: 'The tests are not universally popular and personally I don't find them very useful at all. The workload is heavy and they are very time-consuming.'

Professor Kendrick admitted further research was needed before GPs would accept the QOF revisions: 'The audit I described is not definitive evidence that the indicator is worthwhile.'

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