QOF may impair depression care
Quality and Outcomes Framework (QOF) screening indicators may be hindering management of depression in people with long-term conditions, say researchers.
The team, from the University of Manchester, says that depression could be being missed or under-treated at least partly because QOF depression screening questionnaires encourage "reductionist" approaches to case finding in such patients.
And a tendency to conceptualise depression as a common and understandable response to having a long-term condition and related problems can also present a barrier to identifying and managing depression properly.
The researchers collated evidence from in-depth interviews with 19 mainly primary care healthcare professionals and seven patients with coronary heart disease (CHD) and/or diabetes, as well as three carers.
On analysis, key themes emerged suggesting that barriers to effective depression detection and management arose when either professionals or patients talked about the increased vulnerability to depression when suffering from CHD or diabetes, thereby normalising the feelings of distress.
And, although some GPs said that being encouraged to use screening tools such as the Personal Health Questionnaire had made them screen more actively, many were concerned this had merely formalised the process and had led them to take a less engaged approach to identifying depression.
Writing in the journal BMC Family Practice, Dr Peter Coventry and team conclude: "Improvements in the quality of care for depression in people with long-term conditions are likely to follow on from interventions and service redesign that support and facilitate practitioners to engage patients in more collaborative management strategies."
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By Caroline Price