A trio of new QOF indicators have been proposed to promote tight cholesterol control in diabetes, in the first of a new style of packaged indicators designed to tightly define the treatment GPs deliver.
NICE is piloting the indicators in practices across the country and is now proposing them for the 2013/14 QOF. They reflect a new approach to clinical incentives reported by Pulse last year, packaging indicators as a pragmatic alternative to basing them on hard outcomes.
To achieve a target for successful lipid management for patients over 40 with type 2 diabetes, GPs are expected to commence a moderate dose generic statin within 90 days if the patient’s cholesterol is recorded at more than 4.0 mmol/l in the past year.
For those already being prescribed statins, the expectation is their dose will be increased within 90 days of a cholesterol reading of more than 4.0 mmol/l. If readings remain high, the indicator rewards switching statins.
The target will also be achieved if the patient’s cholesterol reading is 4.0 mmol/l or less in the past year.
Dr Terry McCormack, a GP in Whitby and council member of the Primary Care Cardiovascular Society, said: ‘For diabetes, prescribing statins is more important than hypoglycaemic drugs.’
‘Simvastatin is best tolerated at 40mg, so to get a cholesterol target of 4.0 you need more intensive treatments. Atorvastatin comes off patent in May, so this target is now economically viable.’
The other two proposed diabetes indicators set targets for the percentage of male diabetic patients with a record of being asked about erectile dysfunction in the past 15 months.