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Research

Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b663 (Published 19 March 2009) Cite this as: BMJ 2009;338:b663

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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

Competing interests: No competing interests

12 April 2009
Saji S Damodaran
Associate Professor
Melbourne 3168

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

Competing interests: No competing interests

28 March 2009
Jo Richardson
GP
Island Health E14 3BQ
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