title: Physical health indicators in major mental illness: analysis of QOF data across UK general practice.
abstract: BACKGROUND
  The Quality and Outcomes Framework (QOF) has specific targets for body mass index (BMI) and blood pressure recording in major mental illness (MMI), diabetes, and chronic kidney disease (CKD). Although aspects of MMI (schizophrenia, bipolar disorder, and related psychoses) are incentivised, barriers to care may occur.
  
  
  OBJECTIVE
  To compare payment, population achievement, and exception rates for blood pressure and BMI recording in MMI relative to diabetes and CKD across the UK.
  
  
  METHODS
  Analysis of 2012/2013 QOF data from 9731 UK general practices 2 years after the introduction of the mental health, BMI, and blood pressure QOF indicators.
  
  
  METHODS
  Payment, exception, and population achievement rates for the MMI and CKD blood pressure indicators and the MMI and diabetes BMI indicators were calculated and compared.
  
  
  RESULTS
  UK payment and population achievement rates for BMI recording for MMI were significantly lower than for diabetes (payment: 92.7% versus 95.5% and population achievement: 84.0% versus 92.5%, P<0.001) and exception rates were higher (8.1% versus 2.0%, P<0.001). For blood pressure recording, UK payment and population achievement rates were significantly lower for MMI than for CKD (94.1% versus 97.8% and 87.0% versus 97.1%, P<0.001), while exception rate was higher (6.5% versus 0.0%, P<0.001). This was observed for all countries. Compared with England, Northern Ireland had higher population achievement rates for both mental health indicators, whereas Scotland and Wales had lower rates. There were no cross-jurisdiction differences for CKD and diabetes.
  
  
  CONCLUSIONS
  Differences in payment, exception, and population achievement rates for blood pressure and BMI recording for MMI relative to CKD and diabetes were observed across the UK. These findings suggest potential inequalities in the monitoring of physical health in MMI within the UK primary care system.
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
authors.forename: Julie Langan
authors.initials: JL
authors.lastname: Martin
authors.affiliation: Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde;
authors.forename: Richard
authors.initials: R
authors.lastname: Lowrie
authors.affiliation: Robertson Centre for Biostatistics, University of Glasgow;
authors.forename: Alex
authors.initials: A
authors.lastname: McConnachie
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: McLean
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Frances
authors.initials: F
authors.lastname: Mair
authors.affiliation: General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Smith
mesh_terms: D001795:Blood Pressure Determination; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D058006:General Practice; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D012959:Socioeconomic Factors
keywords: Quality and Outcomes Framework; achievement rates; blood pressure; body mass index; chronic kidney disease; diabetes; major mental illness