Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework

Alabbadi, Ibrahim; Crealey, Grainne; Turner, Kathryn; Rafferty, Thérèse; Keenan, Lynn; Murray, Penny; McElnay, James

doi:10.1007/s11096-009-9339-3

Cited by 4 publications

(5 citation statements)

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Section: Discussionmentioning

confidence: 99%

“…Prescription rates for antidepressants, statins, and other drugs have increased, but this increase is not clearly attributable to the QOF. [46][47][48] The costs of administering the scheme are substantial, and some staff are concerned that primary care has become more biomedical in focus and less patient centered.The QOF has strengthened team working and promoted a diversity of new roles, especially for nurses. Indeed, the QOF may have diminished the workload of general practitioners, enabled them to concentrate on more complex care, and led to teams in which work and knowledge is more distributed among its members.…”

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confidence: 99%

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Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework--A Systematic Review

Gillam

Siriwardena

Steel

2012

The Annals of Family Medicine

257

243

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PURPOSE Primary care practices in the United Kingdom have received substantial fi nancial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care. METHODSFive hundred seventy-fi ve articles were identifi ed by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles. One hundred twenty-four relevant articles were assessed using a modifi ed Downs and Black rating scale for 110 observational studies and a Critical Appraisal Skills Programme rating scale for 14 qualitative studies. Ninety-four studies were included in the review.RESULTS Quality of care for incentivized conditions during the fi rst year of the framework improved at a faster rate than the preintervention trend and subsequently returned to prior rates of improvement. There were modest cost-effective reductions in mortality and hospital admissions in some domains. Differences in performance narrowed in deprived areas compared with nondeprived areas. Achievement for conditions outside the framework was lower initially and has worsened in relative terms since inception. Some doctors reported improved data recording and teamwork, and nurses enhanced specialist skills. Both groups believed that the person-centeredness of consultations and continuity were negatively affected. Patients' satisfaction with continuity declined, with little change in other domains of patient experience. CONCLUSIONSObserved improvements in quality of care for chronic diseases in the framework were modest, and the impact on costs, professional behavior, and patient experience remains uncertain. Further research is needed into how to improve quality across different domains, while minimizing costs and any unintended adverse effects of payment for performance schemes. Health care organizations should remain cautious about the benefi ts of similar schemes. INTRODUCTIONS trong primary care is widely accepted to be a prerequisite for effective, effi cient, equitable health systems and to lead to better population health.1 Introduced in 2004, the UK Quality and Outcomes Framework (QOF) is arguably the most comprehensive national primary care pay-for-performance (P4P) scheme in the world.2 The QOF is more than a payment scheme; it is a complex intervention comprising a number of elements (Table 1), including fi nancial incentives and information technology (computerized prompts and decision support), designed to promote structured and team-based care with the aim of achieving evidence -based quality targets. 462 IM PAC T O F PAY-F O R-P ER F O R M A NC E IN T HE U Kthat led to a practice-based, rather than practitionerbased, contract and investment to reward quality of care through both fi xed and performance-related funding streams. The fi nancial incentives are substantial, with a maximum of 1,000 points available to practices, and an average payment per practice in...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework--A Systematic Review

Gillam

Siriwardena

Steel

2012

The Annals of Family Medicine

257

243

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“… 20 Robust incentives such as the Quality Outcomes Framework (QOF) which rewards general practice for quality care have resulted in an increase in statin prescription across the UK. 21 Participation in the QOF is voluntary and almost all practices take part in it. In England, the use of lipid-lowering medication in a community cohort of adults aged 35 years and older who self-reported ischaemic heart disease or stroke was 79% in men and 72% in women in 2011.…”

Section: Discussionmentioning

confidence: 99%

Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA)

et al. 2015

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ObjectivesThis study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE).DesignThis study is cross-sectional in design using data from the first wave (2009–2011) of The Irish Longitudinal Study on Ageing (TILDA).Setting and participantsThe sample (n=3372) is representative of community living adults aged 50–64 years in Ireland.ResultsStatins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ≥5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines.ConclusionsDespite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ≥5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required.

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“…We found no published studies on contraceptive prescribing trends during the time frame of the observed LARC increases against which to validate our estimates. Previous studies evaluating the effectiveness of QOF on prescribing of other drugs have shown similar increases in the volume of prescribing after the introduction of the QOF in both England and Northern Ireland compared to the period before[27]. Some have suggested that QOF may have rewarded and reinforced existing prescribing behaviours [28].…”

Section: Discussionmentioning

confidence: 92%

Impact of Pay for Performance on Prescribing of Long-Acting Reversible Contraception in Primary Care: An Interrupted Time Series Study

et al. 2014

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BackgroundThe aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.MethodsNegative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.ResultsPrescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR = 1.20, 95% CI = 1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.ConclusionsPay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.

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Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework

Abstract: Strategies should be considered to educate prescribers on cost-effectiveness by increasing their awareness of the negative budgetary impact resulting from early adoption of new and expensive statins and by encouraging generic prescribing.

Cited by 4 publications

References 12 publications

Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework--A Systematic Review

Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework--A Systematic Review

Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA)

Impact of Pay for Performance on Prescribing of Long-Acting Reversible Contraception in Primary Care: An Interrupted Time Series Study

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