Workload impact of the Quality and Outcomes Framework for patients with diabetes: An interrupted time series in general practice

TY - JOUR

T1 - Workload impact of the Quality and Outcomes Framework for patients with diabetes

T2 - An interrupted time series in general practice

AU - Gilbert, C.

AU - Allgar, V.

AU - Doran, T.

N1 - © 2019 British Journal of General Practice. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2019/7/25

Y1 - 2019/7/25

N2 - Background There are substantial concerns about GP workload. The Quality and Outcomes Framework (QOF) has been perceived by both professionals and patients as bureaucratic, but the full impact of the QOF on GP workload is not well known. Aim To assess the impact of the QOF on GP consultation rates for patients with diabetes mellitus. Design and setting This study used interrupted time series of 13 248 745 general practice consultations for 37 065 patients with diabetes mellitus in England. Method Clinical Practice Research Datalink general practice data were used from 2000/2001 to 2014/2015, with introduction of the QOF (1 April 2004) as the intervention, and mean annual GP consultation rates as the primary outcome. Results Mean annual GP clinical consultation rates were 8.10 per patient in 2000/2001, 6.91 in 2004/2005, and 7.09 in 2014/2015. Introduction of the QOF was associated with an annual change in the trend of GP clinical consultation rates of 0.46 (95% confidence interval [CI] = 0.23 to 0.69, P = 0.001) consultations per patient, giving a post-QOF trend increasing by 0.018 consultations per year. Introduction of the QOF was associated with an immediate stepped increase of 'other' out-of-hours and non-clinical encounters, and trend change of 0.57 (95% CI = 0.34 to 0.81, P<0.001) per year, resulting in a post-QOF trend increasing by 0.27 other encounters per year. Conclusion Introduction of the QOF was associated with a modest increase in clinical GP consultation rates and substantial increase in other encounters for patients with diabetes independent of changes in diabetes prevalence. National prevalence of diabetes increased by 90.7% from 2004/2005 to 2014/2015, which, combined with this study's findings, means GPs would have provided nearly double the number of consultations for patients with diabetes over this timescale.

AB - Background There are substantial concerns about GP workload. The Quality and Outcomes Framework (QOF) has been perceived by both professionals and patients as bureaucratic, but the full impact of the QOF on GP workload is not well known. Aim To assess the impact of the QOF on GP consultation rates for patients with diabetes mellitus. Design and setting This study used interrupted time series of 13 248 745 general practice consultations for 37 065 patients with diabetes mellitus in England. Method Clinical Practice Research Datalink general practice data were used from 2000/2001 to 2014/2015, with introduction of the QOF (1 April 2004) as the intervention, and mean annual GP consultation rates as the primary outcome. Results Mean annual GP clinical consultation rates were 8.10 per patient in 2000/2001, 6.91 in 2004/2005, and 7.09 in 2014/2015. Introduction of the QOF was associated with an annual change in the trend of GP clinical consultation rates of 0.46 (95% confidence interval [CI] = 0.23 to 0.69, P = 0.001) consultations per patient, giving a post-QOF trend increasing by 0.018 consultations per year. Introduction of the QOF was associated with an immediate stepped increase of 'other' out-of-hours and non-clinical encounters, and trend change of 0.57 (95% CI = 0.34 to 0.81, P<0.001) per year, resulting in a post-QOF trend increasing by 0.27 other encounters per year. Conclusion Introduction of the QOF was associated with a modest increase in clinical GP consultation rates and substantial increase in other encounters for patients with diabetes independent of changes in diabetes prevalence. National prevalence of diabetes increased by 90.7% from 2004/2005 to 2014/2015, which, combined with this study's findings, means GPs would have provided nearly double the number of consultations for patients with diabetes over this timescale.

KW - Diabetes mellitus

KW - Incentives

KW - Primary care

KW - Workload

UR - http://www.scopus.com/inward/record.url?scp=85070659188&partnerID=8YFLogxK

U2 - 10.3399/bjgp19X704645

DO - 10.3399/bjgp19X704645

M3 - Article

C2 - 31308001

AN - SCOPUS:85070659188

SN - 0960-1643

VL - 69

SP - E570-E577

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 685

ER -