QOF questions 'inaccurate' at screening for depression in diabetes patients

QOF questions designed to screen for depression are providing substandard results when used for people with diabetes, researchers have claimed.

The conclusions came in a study involving 40 patients – 20 men and 20 women – aged 35-83 and with a mean duration of diabetes of 13 years. The study, published in the journal Diabetic Medicine, reopens the debate about the usefulness of the QOF questions for screening for depression. Last summer NICE recommended removing depression indicators from the QOF following GP concerns that they are ineffective and lead to over-diagnosis, but ultimately they were retained. In the new study, patients were asked the two QOF screening questions, which focus on the mood and level of interest in everyday activities, and then given the nine-item Patient Health Questionnaire (PHQ-9), considered by researchers as a ‘gold standard' in helping diagnose depression and assessing its severity. The QOF questionnaire was positive for depression in 14 patients, but only seven of these screened positive with PHQ-9. Two had suicidal feelings. A total of 26 patients screened negative with both QOF and PHQ-9. The research team at Swansea University included Dr Sana Javed, a GP based in Milford Haven, Pembrokeshire at the time of the study, which was presented in poster form at the Diabetes UK 2012 Professional Conference in Glasgow. The paper states: ‘QOF screening has a high sensitivity but lower specificity. This small study supports (the view) that QOF screening questions do not provide accuracy in screening for depression in patients with diabetes.' But Professor Andre Tylee, a former GP and professor of primary care mental health at King's College London, argued that the study has limitations because it involves a small number of patients. He also disputed the assertion that the PHQ-9 is a gold standard screening tool. ‘I don't think you can extrapolate these findings to GP practices, because the researchers have not used a primary care population,' he said. Professor Tylee argued that the QOF questions are useful in screening for depression. ‘We know that patients with diabetes and other long term conditions such as heart disease and COPD are more likely to have depression than the general population, and I think that the QOF questions are the best things GPs have got at the moment. You have to use them wisely, in that you need to follow them up with a longer interviews and a biopsychosocial assessment.'