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Changes to diabetes QOF indicators on horizon

By Editor
22nd August 2018
Clinical guidance, Guidelines NHS England NICE

Proposed changes to diabetes QOF indictors have taken a step closer following a consultation.

NICE has proposed small amendments to some diabetes indicators for general practice, with a consultation running from July 18 to August 8.

The organisation hopes the new indicators will reduce under-treatment in people with less complex needs and overtreatment in those with complex needs.

The proposals include a suggestion there should be just one for people with diabetes without moderate or severe frailty and a reading of 140/80mmHg or less, instead of two indicators, one for the percentage of diabetes patients in whom the last blood pressure reading is 140/80mmHg or less and other for a reading of 150/90mmHg or less.

Proposals have called for two indicators to replace three targets for IFCC-HbA1c, setting targets for those with (75mmol/mol or less) or without (58mmol/mol or less) frailty.

Also, other changes cover total cholesterol targets, asking for the percentage of people with diabetes together with a history of cardiovascular disease (excluding haemorrhagic stroke) who are prescribed a statin, instead of how many people with diabetes had a total cholesterol of 5mmol/l or less in their last test.”

Submitted comments are now being reviewed by the NICE indicator advisory committee.

A document called NICE Indicator Programme: Consultation on proposed amendments to current QOF indicators, stated: “The current QOF indicators for diabetes are applied across all people with diabetes aged 17 years and above. By applying the indicators to all people with diabetes regardless of co-morbidities it may inadvertently lead to both under-treatment and overtreatment (Kearney et al. 2017). People with diabetes with less complex care needs may be undertreated, whilst people with complex care needs may be at risk of overtreatment.

“[Strain WDHope SVGreen AKar PValabhji JSinclair AJ. ] highlighted that intensive glucose lowering treatment has limited benefits for people with type 2 diabetes and may be dangerous for older people, commenting that the target should be modified to allow an individualised approach to care. They propose a care management approach that adjusts care according to an individual’s frailty status with the intention of reducing complications and improving quality of life.

“Kearney et al (2017) highlighted that treatment that is not tailored to the individual can lead to polypharmacy, reduced quality of life and serious adverse effects. This is consistent with recommendations within the NICE guideline on multimorbidity, which highlights the importance of improving quality of life by reducing treatment burden and adverse events.”

NHS England published a review of QOF in July, which called for a step change from one treatment for all, with the proposals focusing on the relevance of individualised care, especially for frail, older people.

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