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QOF depression screening ‘of little benefit’, say UK researchers

GPs have to screen nearly 1,000 patients with cardiovascular disease or diabetes to identify one case of depression concludes a large study that raises fresh questions over the utility of the current depression indicators in the QOF.

The UK study compared the impact of the QOF depression screening questions with usual care by GPs, and found only a ‘small impact' on the number of patients identified with depression.

The research will be welcomed by NICE, as it recommended 14 indicators were removed from the QOF last week including all three depression indicators currently in the framework.

Last summer, NICE recommended two depression indicators from the QOF were removed following GP concerns that the questionnaires the indicators are based on were ineffective, but ultimately they were retained after protests from mental health groups.

Last week, the institute again recommended the depression indicators in QOF were removed, but this time said they should be replaced by two new indicators requiring a review 10 to 35 days after diagnosis and a biopsychosocial assessment in all patients newly diagnosed with depression.

Scottish researchers looked at a database of 1.3 million patients registered with general practices in Scotland and found 4% of patients with cardiovascular disease or diabetes were diagnosed with depression over 12 months.

When they looked at the additional new diagnoses of depression over the 12 months from QOF screening, they found a small but statistically significant increase of 69 cases with screening – 8% of all new diagnoses in patients with CVD and diabetes.

A similarly small relationship was seen with the number of newly initiated antidepressant treatments – 98 patients (3% of all patients with CVD and diabetes).

The figures equated to a number needed to screen for one new diagnosis of depression of 976, and 687 for one new antidepressant treatment.

Study leader Dr Chris Burton, senior research fellow at the University of Edinburgh and a GP in Sanquhar, Scotland, said the study showed QOF screening for depression added very little benefit to those picked up during standard GP care: ‘GPs were picking up depression at other times. Around 4% of the adults with chronic heart disease or diabetes were diagnosed with depression or started an SSRI antidepressant during the year, but in over 90% of cases this could not be attributed to routine screening.

‘Our findings should help NICE in deciding on the future of the DEP1 indicator.'

Dr Liz England, a GPSI in mental health and RCGP clinical commissioning champion in Birmingham, said the findings added to a growing body of evidence questioning whether a different approach was needed in QOF: ‘We should perhaps be focusing our efforts on what we currently have and upskilling our GPs and practice nurses in managing depression.'

But Dr David Smart, a GP in Northampton, Northamptonshire, said it was important there was some form of screening for depression in patients with chronic diseases: ‘I think the two screening questions provide a good framework for delegation to nurses, so that they can feel confident when it comes to dealing with these issues.

‘I know NICE are planning on removing the DEP1 indicator, but if there is no screening for depression then what do you do? There's a sevenfold incidence in depression in patients with two or more long-term conditions, and a more holistic approach to assessment – increasing awareness in GP practices – would be beneficial for these patients.'