Physical health indicators in major mental illness: evidence of reduced uptake from UK-Wide QOF data.

<b>Background</b> The Quality and Outcome Framework (QOF) has specific targets for Body Mass Index (BMI) and Blood Pressure (BP) recording in Major Mental Illness (MMI), Diabetes and Chronic Kidney Disease (CKD). Although aspects of MMI (schizophrenia, bipolar disorder and related psychoses) are incentivised, barriers to care may occur.<p></p> <b>Aim</b> To compare payment, population achievement and exception rates for BP and BMI recording in MMI relative to diabetes and CKD across the UK.<p></p> <b>Design and setting</b> Analysis of 2012/2013 QOF data from 9,731 UK General Practices one year after the introduction of the Mental health BMI and BP QOF indicators.<p></p> <b>Method</b> Payment, exception and population achievement rates for the MMI and CKD BP indicators and the MMI and Diabetes BMI indicators were calculated and compared.<p></p> <b>Results</b> UK payment and population achievement rates for BMI recording for MMI were significantly lower than for diabetes (payment: 92.7% vs. 95.5% and population achievement: 84.0% vs. 92.5%, p<0.001) and exception rates were higher (8.1% vs. 2.0%, p<0.001). For BP recording, UK payment and population achievement rates were significantly lower for MMI than for CKD (94.1% vs. 97.8% and 87.0% vs. 97.1%, p<0.001) while exception rate was higher (6.5% vs. 0.0%, p<0.001). This was observed for all countries. Compared to England, Northern Ireland had higher population achievement rates for both Mental Health Indicators, whereas Scotland and Wales had lower rates. There were no cross-jurisdiction differences for CKD and Diabetes.<p></p> <b>Conclusion</b> Differences in payment, exception and population achievement rates for BP and BMI recording for MMI relative to CKD and Diabetes were observed across the UK. These findings suggest potential inequalities in the monitoring of physical health in MMI within the UK primary care system