Physical health indicators in major mental illness: analysis of QOF data across UK general practice

Julie Langan Martin; Richard Lowrie; Alex McConnachie; Gary McLean; Frances Mair; Stewart W Mercer; Daniel J Smith

doi:10.3399/bjgp14X681829

Physical health indicators in major mental illness: analysis of QOF data across UK general practice

Br J Gen Pract. 2014 Oct;64(627):e649-56. doi: 10.3399/bjgp14X681829.

Authors

Julie Langan Martin¹, Richard Lowrie², Alex McConnachie³, Gary McLean¹, Frances Mair⁴, Stewart W Mercer⁵, Daniel J Smith¹

Affiliations

¹ Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
² Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde;
³ Robertson Centre for Biostatistics, University of Glasgow;
⁴ Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
⁵ General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.

Abstract

Background: The Quality and Outcomes Framework (QOF) has specific targets for body mass index (BMI) and blood pressure recording in major mental illness (MMI), diabetes, and chronic kidney disease (CKD). Although aspects of MMI (schizophrenia, bipolar disorder, and related psychoses) are incentivised, barriers to care may occur.

Aim: To compare payment, population achievement, and exception rates for blood pressure and BMI recording in MMI relative to diabetes and CKD across the UK.

Design and setting: Analysis of 2012/2013 QOF data from 9731 UK general practices 2 years after the introduction of the mental health, BMI, and blood pressure QOF indicators.

Method: Payment, exception, and population achievement rates for the MMI and CKD blood pressure indicators and the MMI and diabetes BMI indicators were calculated and compared.

Results: UK payment and population achievement rates for BMI recording for MMI were significantly lower than for diabetes (payment: 92.7% versus 95.5% and population achievement: 84.0% versus 92.5%, P<0.001) and exception rates were higher (8.1% versus 2.0%, P<0.001). For blood pressure recording, UK payment and population achievement rates were significantly lower for MMI than for CKD (94.1% versus 97.8% and 87.0% versus 97.1%, P<0.001), while exception rate was higher (6.5% versus 0.0%, P<0.001). This was observed for all countries. Compared with England, Northern Ireland had higher population achievement rates for both mental health indicators, whereas Scotland and Wales had lower rates. There were no cross-jurisdiction differences for CKD and diabetes.

Conclusion: Differences in payment, exception, and population achievement rates for blood pressure and BMI recording for MMI relative to CKD and diabetes were observed across the UK. These findings suggest potential inequalities in the monitoring of physical health in MMI within the UK primary care system.

Keywords: Quality and Outcomes Framework; achievement rates; blood pressure; body mass index; chronic kidney disease; diabetes; major mental illness.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Blood Pressure Determination
Body Mass Index
Diabetes Mellitus, Type 2 / diagnosis
Diabetes Mellitus, Type 2 / epidemiology*
England / epidemiology
General Practice*
Humans
Mental Disorders / diagnosis
Mental Disorders / epidemiology*
Outcome Assessment, Health Care
Practice Patterns, Physicians' / statistics & numerical data*
Primary Health Care*
Quality Assurance, Health Care
Quality Indicators, Health Care
Renal Insufficiency, Chronic / diagnosis
Renal Insufficiency, Chronic / epidemiology*
Socioeconomic Factors