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The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis.
- Source :
-
BMJ open [BMJ Open] 2014 Aug 20; Vol. 4 (8), pp. e005178. Date of Electronic Publication: 2014 Aug 20. - Publication Year :
- 2014
-
Abstract
- Objective: To evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions.<br />Design: Interrupted time series analysis.<br />Setting: General practices in Leeds, UK.<br />Participants: 65 (58%) of 112 general practices shared data on 37,229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101,008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma).<br />Intervention: Incentivised case finding for depression using two standard screening questions.<br />Main Outcome Measures: Clinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates.<br />Results: New diagnoses of depression increased from 21 to 94/100,000 per month in targeted patients between the periods 2002-2004 and 2007-2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100,000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=-4.14, p<0.01).<br />Conclusions: Incentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
- Subjects :
- Antidepressive Agents economics
Coronary Disease epidemiology
Coronary Disease psychology
Depression economics
Depression epidemiology
Depression etiology
Diabetes Mellitus epidemiology
Diabetes Mellitus psychology
Humans
Interrupted Time Series Analysis
Outcome Assessment, Health Care
Physician Incentive Plans economics
Prescriptions
Quality Improvement
Quality of Health Care
United Kingdom epidemiology
Coronary Disease economics
Depression diagnosis
Diabetes Mellitus economics
General Practice
Physician Incentive Plans organization & administration
Physicians, Primary Care economics
Reimbursement, Incentive organization & administration
Subjects
Details
- Language :
- English
- ISSN :
- 2044-6055
- Volume :
- 4
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- BMJ open
- Publication Type :
- Academic Journal
- Accession number :
- 25142262
- Full Text :
- https://doi.org/10.1136/bmjopen-2014-005178