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NICE proposes changes to QOF diabetes indicators to consider patient frailty

GPs could see different blood pressure and blood sugar level targets for frail and non-frail diabetes patients, if proposed QOF changes go ahead.

The new indicators have been proposed by NICE in the hope that they will reduce under-treatment in patients with less complex needs and overtreatment in those with more complex care needs.

This comes after a review of QOF proposed cutting a quarter of the indicators but keeping the proportion of practice income provided by the framework the same.

The NICE proposals suggest that instead of two indicators – one for the percentage of diabetes patients in whom the last blood pressure reading is 140/80 mmHg or less and other for a reading of 150/90 mmHg or less – there should be just one for diabetes patients without moderate or severe frailty and a reading of 140/80 mmHg or less.

Two indicators have also been proposed to replace three targets for IFCC-HbA1c, setting targets for those with (75 mmol/mol or less) or without (58 mmol/mol or less) frailty.

NICE said: ‘The current QOF indicators for diabetes are applied across all people with diabetes aged 17 years and above. By applying the indicators to all people with diabetes regardless of co-morbidities it may inadvertently lead to both under-treatment and overtreatment.

‘People with diabetes with less complex care needs may be undertreated, whilst people with complex care needs may be at risk of overtreatment.’

Additional changes were suggested to the total cholesterol target for diabetes patients, asking for the percentage of patients with diabetes and a history of CVD (excluding haemorrhagic stroke) who are prescribed a statin, instead of how many diabetes patients had a total cholesterol of 5 mmol/l or less in their last test.

NICE also proposed adding people with resolved atrial fibrillation to the AF register, as they remain at a higher risk of stroke or transient ischaemic attack and continue to benefit from anticoagulation therapy.

The consultation on the proposed amendments ran from 18 July to 8 August 2018, with submitted comments now being reviewed by the NICE indicator advisory committee.

According to a Pulse survey, almost half of GPs want to see the QOF scrapped, with many suggesting they would prefer the money to be put into the global sum.

New indicators proposed by NICE

  • The percentage of patients with diabetes without moderate or severe frailty, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less.
  • The percentage of patients with diabetes without moderate or severe frailty, on the register, in whom the last IFCC-HbA1c is 58 mmol/mol or less in the preceding 12 months.
  • The percentage of patients with diabetes with moderate or severe frailty, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months.
  • The percentage of patients with diabetes aged 40 years and over, no history of CVD, and without moderate or severe frailty, who are prescribed a statin.
  • The percentage of patients with diabetes and a history of CVD (excluding haemorrhagic stroke) who are prescribed a statin.

Source: NICE

Readers' comments (2)

  • Over the past 10 years, there has been a move to make QOF targets 'stricter' - I think because too many GPs were hitting them.

    That was always going to lead to overtreatment related harm, and clinicians and non-clinicians who instigated those targets clearly have to have a good look in the mirror. The new system seems much more sensible, as long as the actual target figure is not too tight.

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  • You cant win if you exclude patient on a clinical need basis the local establishment are on you like the stazi to ask why your not following protocol and you have a high exclusion rate.Such is medicine in the UK.Communist system and communist style totalitarian regulation.

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