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Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink

Research output: Contribution to journalArticle

Published copy (DOI)

Author(s)

  • Evangelos Kontopantelis
  • Ivan Olier
  • Claire Planner
  • David Reeves
  • Darren M Ashcroft
  • Linda Gask
  • Timothy Doran
  • Siobhan Reilly

Department/unit(s)

Publication details

JournalBMJ Open
DatePublished - 16 Dec 2015
Volume5
Number of pages11
Pages (from-to)e008650
Original languageEnglish

Abstract

OBJECTIVES: Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004.

DESIGN: Retrospective cohort study using individual patient data collected from 2000 to 2012.

SETTING: 627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database.

PARTICIPANTS: SMI cases (346,551) matched to 5 individuals without SMI (1,732,755) on age, gender and general practice.

OUTCOME MEASURES: Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF.

RESULTS: Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8-10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022).

CONCLUSIONS: The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients.

    Research areas

  • Adult, Female, Humans, Interrupted Time Series Analysis, Longitudinal Studies, Male, Mental Disorders, Middle Aged, Practice Patterns, Physicians', Primary Health Care, Referral and Consultation, Retrospective Studies, Severity of Illness Index, United Kingdom, Journal Article, Observational Study, Research Support, Non-U.S. Gov't

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