Evidence in diabetes and depression

Medical evidence is always changing. The QOF is meant to be based on robust evidence. Problems arise when new evidence arrives between the decisions being made to include something and their actual implementation. We are now a week away from several new indicators coming on line and the evidence for two of them is starting to look less than great.

Most seriously an editorial in the BMJ(paying customers only) suggests that the new targets for diabetes are unlikely to improve the lot of patients with the condition. In a review of the editorial even the NHS Nation Prescribing Centre is concerned by these indicators. The tighter indicators come in on the 1st of April.

A research paper, again in the BMJ, looked at the use of depression questionnaires in practice (free to read!). It found them to be inconsistent with each and having little bearing on treatment. All rather troubling as the number required to be administered under QOF is to double next month.

Now things certainly do change but the evidence for either of these interventions was previously weak and yet they were still included. It is to be hoped that there will be a more robust attitude to evidence when NICE takes over the assessment of possible indicators. There is little that is dramatic in the government response to the QOF consultation but it was rather good to see just how many GPs took the time to respond to the consultation. My response is here. Unfortunately we will now have at least a year incentivising GPs to do some things that are not really supported by good evidence.

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