Physical health indicators in major mental illness: data from the quality and outcome framework in the UK (original) (raw)
Langan-Martin, Julie 
ORCID: https://orcid.org/0000-0002-0589-3464, Lowrie, Richard, McConnachie, Alex ORCID: https://orcid.org/0000-0002-7262-7000, McLean, Gary, Mair, Frances ORCID: https://orcid.org/0000-0001-9780-1135, Mercer, Stewart ORCID: https://orcid.org/0000-0002-1703-3664 and Smith, Daniel ORCID: https://orcid.org/0000-0002-2267-1951(2015) Physical health indicators in major mental illness: data from the quality and outcome framework in the UK.Lancet, 385(S1), S61. (doi: 10.1016/S0140-6736(15)60376-2) (PMID:25267051)
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Abstract
BackgroundIn the UK, the Quality and Outcome Framework (QOF) has specific targets for general practictioners to record body-mass index (BMI) and blood pressure (BP) in major mental illness, diabetes, and chronic kidney disease. Although incentives are given for aspects of major mental illness (schizophrenia, bipolar disorder, and related psychoses), barriers to care can occur. Our aim was to compare recording of specific targets for BP and BMI in individuals with major mental illness relative to diabetes and chronic kidney disease across the UK.
Methods Using 2012 and 2013 QOF data from 9731 general practices across all four countries in the UK, we calculated median payment, population achievement, and exception rates for BP indicators in major mental illness and chronic kidney disease and BMI indicators in major mental illness and diabetes. Differences in unweighted rates between practices in the same UK country were tested with a sign test. Differences in population achievement rate between practices in different countries were compared with those in England by use of a quantile regression analysis. Findings UK payment and population achievement rates for BMI recording in major mental illness were significantly lower than were those in diabetes (payment 92·7% vs 95·5% and population achievement 84·0% vs 92·5%, p<0·0001) and exception rates were higher (8·1% vs 2·0%, p<0·0001). For BP recording, UK payment and population achievement rates were significantly lower for major mental illness than for chronic kidney disease (94·1% vs 97·8% and 87·0% vs 97·1%, p<0·0001), whereas exception rate was higher (6·5% vs 0·0%, p<0·0001). This difference was observed for all UK countries. Median population achievement rates for BMI and BP recording in major mental illness were significantly lower in Scotland than in England (for BMI −1·5%, 99% CI −2·7 to −0·3, and for BP −1·8%, −2·7 to −0·9; p<0·0001 for both). There were no cross-jurisdiction differences for chronic kidney disease and diabetes. Interpretation We found lower payment rates, higher exception rates, and lower population achievement rates for BMI and BP recording in major mental illness than in diabetes and chronic kidney disease throughout the UK. We also found variation in these rates between countries. This finding is probably multifactorial, reflecting a combination of patient, clinician, and wider organisational factors; however, it might also suggest inequality in access to certain aspects of health care for people with major mental illness.| Item Type: | Articles |
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| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Smith, Professor Daniel and Langan-Martin, Professor Julie and Mair, Professor Frances and Mercer, Professor Stewart and Lowrie, Dr Richard and McLean, Dr Gary and McConnachie, Professor Alex |
| Authors: | Langan-Martin, J., Lowrie, R., McConnachie, A., McLean, G., Mair, F., Mercer, S., and Smith, D. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson CentreCollege of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and WellbeingCollege of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care |
| Journal Name: | Lancet |
| Publisher: | The Lancet Publishing Group |
| ISSN: | 0140-6736 |
| ISSN (Online): | 1474-547X |
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Deposit and Record Details
| ID Code: | 104782 |
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| Depositing User: | Mrs Afshan Fairley |
| Datestamp: | 13 Apr 2015 10:22 |
| Last Modified: | 02 May 2025 05:35 |
| Date of first online publication: | February 2015 |