Quality in Primary Care Open Access

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Should there be a Quality and Outcomes Framework domain for osteoarthritis? A cross-sectional survey in general practice

Lorna E Clarson, Barbara I Nicholl, Annette Bishop, John Edwards, Rebecca Daniel, Christian Mallen

BackgroundDespite being a chronic condition with a high prevalence and significant associated morbidity that is managed predominantly in primary care, osteoarthritis (OA) does not feature in the Quality and Outcomes Framework (QOF) component of theUK general practice contract. The aim of this study was to determine whether general practitioners (GPs) thought OA should be added as a QOF domain, and the potential items for inclusion. MethodsA cross-sectional postal survey of 2500 UK GPs randomly selected from Binley’s database of currently practising GPs was conducted. The survey asked if OA should be added as a domain to QOF, how many points should be allocated to it and what indicators should be included. ResultsResponses were received from 768 GPs, of whom 70.4%were male and 89.1%were partners in their practice. The majority (82.6%; n = 602) felt that OA should not be included as a QOF domain. Significant predictors of support for the addition of an OA domain to QOF included having a special interest in musculoskeletal  disease (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.26–3.03), a higher research degree (OR 3.98, 95% CI 1.31– 12.10) and having read the National Institute for Health and Clinical Excellence (NICE) guidance on the management of OA (OR 1.62, 95% CI 1.04– 2.54). Being a GP principal was the only negative association (OR 0.48, 95% CI 0.23–0.99). Preferred potential indicators for an OA QOF were analgesia review, exercise advice and patient education. ConclusionsThe majority of respondents felt that OA should not be included as a QOF domain, although it is unclear whether this reflected views particular to OA, or on the addition of any new domain to QOF. Those supporting an OA QOF domain tended to prefer potential indicators that are in line with current published guidance, despite a significant proportion reporting that they had not read the NICE guidelines on the management of OA.