The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis
Open accessAbstract
Objective: To evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions. Design: Interrupted time series analysis. Setting: General practices in Leeds, UK. Participants: 65 (58%) of 112 general practices shared data on 37 229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101 008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma). Intervention: Incentivised case finding for depression using two standard screening questions. Main outcome measures: Clinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates. Results: New diagnoses of depression increased from 21 to 94/100 000 per month in targeted patients between the periods 2002–2004 and 2007–2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100 000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=−4.14, p<0.01). Conclusions: Incentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment.
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Changes in coding strategies may impact validity or consistency of data.
“In addition, changes in coding strategies may impact validity or consistency of data.”
From The Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. (2015) · cites this paper as [62]
The introduction of provider billing incentive codes may change the likelihood of a code being used over time.
“For example, the introduction of provider billing incentive codes may change the likelihood of a code being used over time [62,63].”
From The Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. (2015) · cites this paper as [62]
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- Authors
- McLintock, K., Russell, A. M., Alderson, S. L., West, R., House, A., Westerman, K., & Foy, R.
- Affiliations
- University of Leeds (GB)
- NHS England (GB)
- Corresponding author
- McLintock, Kate
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2014-08
- Volume
- 4
- Issue
- 8
- Pages
- e005178
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4139660
- OpenAlex
- W2041878767
- Cited by
- 44
- References
- 51
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 6 · 2017: 4 · 2016: 4 · 2015: 5 · 2014: 1
- FWCI
- 8.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research (PB-PG-0110-21046)
- University of Leeds
- Research for Patient Benefit Programme
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- depression, case finding, financial incentives, Quality and Outcomes Framework, diabetes mellitus, coronary artery disease, antidepressant prescribing, depression screening, chronic disease, general practice, overdiagnosis
- MeSH terms
- Antidepressive Agents, Coronary Disease, Depression, Diabetes Mellitus, United Kingdom, Humans, Physician Incentive Plans, Quality of Health Care, Reimbursement, Incentive, Outcome Assessment, Health Care, Prescriptions, General Practice, Physicians, Primary Care, Quality Improvement, Interrupted Time Series Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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