Gallagher N. Cardwell C. et al. Diabetic Medicine Doi: 10.1111/dme.12575
This fascinating paper reviewed the impact of Quality and Outcomes Framework (QOF) which the authors called “the most comprehensive pay-for-performance scheme for primary care in the world to date,” on diabetic care. I have seen suggested before, that the way we are paid will almost certainly influence the way we practice medicine and this paper backs up this assertion. This research searched and analysed a General Practice database and followed up 100 000 patients over a 10 year period. The researchers concluded that earlier initiation of pharmacological therapy in type 2 diabetes is directly linked to the QOF initiative, is an interesting observation. This change in behaviour could also be linked to better understanding and education about diabetes, spread through published guidelines. The conclusion begs the question; does this faster introduction of drug therapy result in significantly better clinical outcomes and provide good value for money for the UK taxpayer? This is not an academic question as according to the paper QOF costs more than £1 billion a year.