Changes in rates of recorded depression in English primary care 2003-2013: time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF)
Changes in rates of recorded depression in English primary care 2003-2013: time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF)
Background: Depression may be increasing, particularly since the economic recession. Introduction of quality outcomes framework (QOF) performance indicators may have altered GP recording of depression.
Methods: Time trend analyses of GP recording of depression before and after the recession (from April 2008), and the QOF (from April 2006), were conducted on anonymised consultation data from 142 English practices contributing to the Clinical Practice Research Datalink, April 2003-March 2013.
Results: 293,596 patients had computer codes for depressive diagnoses or symptoms in the 10 years. Prevalence of depression codes fell from 44.6 (95% CI 44.2, 45.0) per 1000 person years at risk (PYAR) in 2003/2004 to 38.0 (37.7, 38.3) in 2008/2009, rising to 39.5 (39.2, 39.9) in 2012/2013. Incidence of first-ever depression codes fell from 11.9 (95% CI 11.7, 12.1) per 1000 PYAR in 2003/2004 to 9.5 (9.3, 9.7) in 2008/2009, rising to 10.0 (9.8, 10.2) in 2012/1203. Prevalence increased in men but not women following the recession, associated with increased unemployment. Following introduction of the QOF, GPs used more non-QOF-qualifying symptom or other codes than QOF-qualifying diagnostic codes for new episodes.
Limitations: Clinical data recording is probably incomplete. Participating practices were relatively large and not representative across English regions.
Conclusions: Rates of recorded depression in English general practices were falling prior to the economic recession but increased again subsequently, among men, associated with increased unemployment. GPs responded to the QOF by switching from diagnostic to symptom codes, removing most depressed patients from the denominator for measuring GP performance in assessing depression.
depression, prevalence, primary care, economic recession, pay for performance, QOF
68-78
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
15 July 2015
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Geraghty, Adam W.A.
2c6549fe-9868-4806-b65a-21881c1930af
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Kendrick, Tony, Stuart, Beth, Newell, Colin, Geraghty, Adam W.A. and Moore, Michael
(2015)
Changes in rates of recorded depression in English primary care 2003-2013: time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF).
Journal of Affective Disorders, 180, .
(doi:10.1016/j.jad.2015.03.040).
Abstract
Background: Depression may be increasing, particularly since the economic recession. Introduction of quality outcomes framework (QOF) performance indicators may have altered GP recording of depression.
Methods: Time trend analyses of GP recording of depression before and after the recession (from April 2008), and the QOF (from April 2006), were conducted on anonymised consultation data from 142 English practices contributing to the Clinical Practice Research Datalink, April 2003-March 2013.
Results: 293,596 patients had computer codes for depressive diagnoses or symptoms in the 10 years. Prevalence of depression codes fell from 44.6 (95% CI 44.2, 45.0) per 1000 person years at risk (PYAR) in 2003/2004 to 38.0 (37.7, 38.3) in 2008/2009, rising to 39.5 (39.2, 39.9) in 2012/2013. Incidence of first-ever depression codes fell from 11.9 (95% CI 11.7, 12.1) per 1000 PYAR in 2003/2004 to 9.5 (9.3, 9.7) in 2008/2009, rising to 10.0 (9.8, 10.2) in 2012/1203. Prevalence increased in men but not women following the recession, associated with increased unemployment. Following introduction of the QOF, GPs used more non-QOF-qualifying symptom or other codes than QOF-qualifying diagnostic codes for new episodes.
Limitations: Clinical data recording is probably incomplete. Participating practices were relatively large and not representative across English regions.
Conclusions: Rates of recorded depression in English general practices were falling prior to the economic recession but increased again subsequently, among men, associated with increased unemployment. GPs responded to the QOF by switching from diagnostic to symptom codes, removing most depressed patients from the denominator for measuring GP performance in assessing depression.
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AAM Changes in recorded depression in English primary care 2003-2013.docx
- Accepted Manuscript
More information
Accepted/In Press date: 24 March 2015
e-pub ahead of print date: 14 April 2015
Published date: 15 July 2015
Keywords:
depression, prevalence, primary care, economic recession, pay for performance, QOF
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 375689
URI: http://eprints.soton.ac.uk/id/eprint/375689
ISSN: 0165-0327
PURE UUID: 46af557e-168a-4ef1-b39b-1262b2df220e
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Date deposited: 31 Mar 2015 13:23
Last modified: 15 Mar 2024 03:36
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Author:
Colin Newell
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