title: Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink.
abstract: OBJECTIVE
  Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004.
  
  
  METHODS
  Retrospective cohort study using individual patient data collected from 2000 to 2012.
  
  
  METHODS
  627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database.
  
  
  METHODS
  SMI cases (346,551) matched to 5 individuals without SMI (1,732,755) on age, gender and general practice.
  
  
  METHODS
  Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF.
  
  
  RESULTS
  Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8-10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022).
  
  
  CONCLUSIONS
  The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients.
authors.affiliation: Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: Manchester Institute of Biotechnology, University of Manchester, Manchester, UK.
authors.forename: Ivan
authors.initials: I
authors.lastname: Olier
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Planner
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: Department of Health Sciences, University of York, York, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Doran
authors.affiliation: Division of Health Research, University of Lancaster, Lancaster, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Reilly
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
keywords: MENTAL HEALTH; PRIMARY CARE; PSYCHIATRY; PUBLIC HEALTH