title: Assessing depression severity using the UK Quality and Outcomes Framework depression indicators: a systematic review.
abstract: BACKGROUND
  Depression is a major cause of chronic ill-health and is managed in primary care. Indicators on depression severity assessment were introduced into the UK Quality and Outcomes Framework (QOF) in 2006 and 2009. QOF is a pay-for-performance scheme and indicators should have evidence to support their use; potential unintended consequences should also have been considered.
  
  
  OBJECTIVE
  To review the effectiveness of routine assessment of depression severity using structured tools in primary care, and to determine the views of GPs and patients regarding their use.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Studies were identified by searching electronic databases; study selection, data abstraction, and quality assessment were carried out by one reviewer, with checks from other authors and GRADE (grading of recommendations, assessment, development and evaluation) tables completed for included effectiveness studies.
  
  
  RESULTS
  Eight studies met the eligibility criteria. There was very low-quality evidence that assessing severity in a structured way at diagnosis using a validated tool led to interventions that were appropriate to the severity of depression. Patients and GPs had different perceptions of the assessment of depression at diagnosis, with patients being more positive. GPs highlighted unintended consequences. There was low-quality evidence that structured assessment at follow-up led to increased rates of remission and response, but changes to management were not seen. Patients used this assessment to measure their own response to treatment.
  
  
  CONCLUSIONS
  Any estimate of the effect of structured assessment of depression severity in UK general practice is uncertain. GPs consider routine use of questionnaires as incentivised by the QOF has unintended consequences, which could adversely affect patient care.
authors: Health and Social Care Directorate, National Institute for Healthand Care Excellence (NICE), Manchester.
authors: Elizabeth J
authors: EJ
authors: Shaw
authors: Daniel
authors: D
authors: Sutcliffe
authors: Terence
authors: T
authors: Lacey
authors: Tim
authors: T
authors: Stokes
mesh_terms: D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D010819:Physician's Role; D019984:Quality Indicators, Health Care; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology
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