Tony Kendrick1, Beth Stuart2, Colin Newell2, Adam W A Geraghty2, Michael Moore2. 1. Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK. Electronic address: A.R.Kendrick@Southampton.ac.uk. 2. Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
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.
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 depressedpatients from the denominator for measuring GP performance in assessing depression.
Authors: Rebecca C Rossom; Leif I Solberg; Emily D Parker; A Lauren Crain; Robin Whitebird; Michael Maciosek; Beth Molitor; Michael Trangle; Jürgen Unützer Journal: Med Care Date: 2016-11 Impact factor: 2.983
Authors: Jane Sarginson; Roger T Webb; S Jill Stocks; Aneez Esmail; Shruti Garg; Darren M Ashcroft Journal: J Affect Disord Date: 2017-01-02 Impact factor: 4.839
Authors: Masao Iwagami; Laurie A Tomlinson; Kathryn E Mansfield; Helen I McDonald; Liam Smeeth; Dorothea Nitsch Journal: Pharmacoepidemiol Drug Saf Date: 2017-04-11 Impact factor: 2.890
Authors: Becky Mars; Jon Heron; David Kessler; Neil M Davies; Richard M Martin; Kyla H Thomas; David Gunnell Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-11-24 Impact factor: 4.328
Authors: Tony Kendrick; Adam W A Geraghty; Hannah Bowers; Beth Stuart; Geraldine Leydon; Carl May; Guiqing Yao; Wendy O'Brien; Marta Glowacka; Simone Holley; Samantha Williams; Shihua Zhu; Rachel Dewar-Haggart; Bryan Palmer; Margaret Bell; Sue Collinson; Imogen Fry; Glyn Lewis; Gareth Griffiths; Simon Gilbody; Joanna Moncrieff; Michael Moore; Una Macleod; Paul Little; Christopher Dowrick Journal: Trials Date: 2020-05-24 Impact factor: 2.279