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RESEARCH: Christopher Dowrick, Geraldine M Leydon, Anita McBride, Amanda Howe, Hana Burgess, Pamela Clarke, Sue Maisey, and Tony Kendrick Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study BMJ 2009; 338: b663 [Abstract] [Full text]

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Over-incentivising general practice

Jo Richardson   (28 March 2009)

Routine use of clinical measures: a common issue with doctors

Saji S Damodaran   (11 April 2009)

Over-incentivising general practice 28 March 2009
Jo Richardson, GP Island Health E14 3BQ Send response to journal: Re: Over-incentivising general practice	Dowrick et al report that GPs were generally sceptical about the benefits of depression questionnaires, and encountered practical challenges to their use. Although "sometimes" GPs used questionnaire scores to change their clinical behaviour on most occasions they clearly did not, instead relying on a holistic interpretation of the patient`s situation to devise the most appropriate management plan, with the patient. From April 2009, the average sized GP practice with average reported depression prevalence will be incentivised to the tune of about £2500 to readminster a depression questionnaire 5-12 weeks after the initial questionnaire assessment. Whilst there is no doubt that care of patients with mental health problems in general practice should be improved, this may just be an incentive too far for extension of an assessment process of dubious utility and validity. Competing interests: None declared
Routine use of clinical measures: a common issue with doctors 11 April 2009
Saji S Damodaran, Associate Professor Melbourne 3168 Send response to journal: Re: Routine use of clinical measures: a common issue with doctors	Dowrick et al paper restates the common issue we have seen in routine clinical practice where patients value the role of measures and doctors defend their "clinical judgment". Routine use of clinical outcome measures is a national policy initiative in Australian mental health strategy. However the participation and take up by clinicians including psychiatrists are less than 50% even after a decade of training and resource support. Common observation about the low take up are the general suspicion of clinicians about the validity of such measures, perceived "abuse" of the data " in funding decisions and lack of feedback on the longitudinal data on patients and patients group to change practice behaviors. Another area which is not addressed is the disconnect between real clinical practice environment and resources against the expectation of more data collection and use of questionnaires. Objective measures are eminently useful provided the measures are reliable and reasonably valid.Doctors routinely use severity measures by diagnostic tests from Blood Pressure, Diabetes and any other diagnostic tools. The take up is high as there is a clear understanding about the objective validity and reliability of such measures. It is important that such measures must be identified and introduced as a routine part, which fits with the current practice environment. Routine use of practice nurses or other professional who are involved in practice supports can facilitate such initiatives. Competing interests: None declared