Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink

Abstract

ObjectivesLittle 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.DesignRetrospective cohort study using individual patient data collected from 2000 to 2012.Setting627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database.ParticipantsSMI cases (346 551) matched to 5 individuals without SMI (1 732 755) on age, gender and general practice.Outcome measuresConsultation 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.ResultsOver 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).ConclusionsThe 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.

Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England

“…The volume comparators used in this instance compare drug prescribing between different practices and they are designed to weight individual practice or organisation populations for age and sex while taking into account the different needs of people who will be receiving that treatment. All three mental illness measures were attributed to LSOAs using spatial methodologies (Kontopantelis et al, 2015b). More information on the data and the attribution methodology are provided in the online Supplementary material.…”

“…Moreover, cuts to local government budget and the benefit reforms have hit the most deprived and poorest parts of the country hardest, leading to widening health inequalities (Taylor-Robinson and Gosling, 2011;Crawford and Phillips, 2012;Barr et al, 2016). Finally, it is suggested that recording of SMI in primary care exhibits a greater increase in the most deprived areas (Kontopantelis et al, 2015a). Our models also indicated an unexpected negative association for prevalence of depression and antidepressant prescription volume with social fragmentation and we explored this association across different residential settings to conclude that there may be several reasons for the unexpected association observed.…”

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness

“…We found slightly lower levels of continuity than those in an earlier study of family physician continuity for people with long-term mental illness in the United Kingdom, 53 but much lower than those found in studies looking only at specialist mental health care. 17,18 Higher, and rising, 54 rates of consultation in family practice may contribute to these differences. Relational continuity in English family practices may be affected by reductions in full-time working and increasing practice size.…”

Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness

“…The 2003/04 year was excluded as per previous studies[6], as some practices were preparing for the introduction of the QOF in the year prior to its introduction.…”