New Survey Of GPs Reveals Support For Continued Focus On Cholesterol-lowering In QOF1, UK

Main Category: Cholesterol
Also Included In: Primary Care / General Practice
Article Date: 18 May 2009 - 2:00 PDT

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The results of a new survey of 400 UK healthcare professionals, conducted by TNS Healthcare UK and sponsored by Merck Sharp & Dohme Limited and Schering-Plough Limited, reveal that the majority of GPs surveyed (82% of the 100 GPs) believe that the cholesterol indicator (CHD 08) should remain a priority area in the Quality and Outcomes Framework (QOF).1 They also believe that it would be useful for the QOF to reflect National Institute for Health and Clinical Excellence (NICE) guidelines, with 67% of GPs supporting specific lower lipid targets for type 2 diabetes and 65% for secondary prevention.1

These results follow recent QOF performance data (2007/8 results) which showed that 98.9% of points were gained for the cholesterol indicator CHD 08 (% of CHD patients with ≤5mmol/L total cholesterol2).3 However, in order to gain full points, only 70% of patients in a practice are required to reach the indicator.2 According to QOF figures, 82.5% of patients reached indicator CHD 08.3 The 17.5% of patients who did not reach the indicator are in addition to those patients who were excluded from the calculations from the start due to exception reporting (a mean of 8.96% of patients in England for CHD 084).5

Dr Stewart Findlay, Treasurer of the Primary Care Cardiovascular Society and GP in Bishop Auckland, County Durham commented, "While performance against the current CHD 08 indicator is high, it is important to look behind the top line figure. We are still failing approximately a quarter of our patients against the current standard and many more if we look to achieve the lower levels suggested by NICE. Standards can still be raised in cholesterol management and incentives should be retained and strengthened within QOF to ensure that this happens."

Treating patients to lower cholesterol levels recommended by NICE

The survey also revealed a wide gap between what the GPs consider best practice lipid management and how they say they manage patients on a day-to-day basis.1 In an 'ideal world', 81% of GPs believe that best practice lipid management for type 2 diabetes is treatment to <4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol,1 in line with NICE guidelines.6 However, just 44% say that they typically treat type 2 diabetes patients to these levels in everyday practice, with the resources they have available.1

The results were similar for treatment of secondary prevention patients, with 79% of GPs questioned saying they believe that in an 'ideal world' best practice lipid management is treatment to <4mmol/L total cholesterol and/or <2mmol/L LDL-cholesterol,1 again in line with NICE guidelines.7 Yet only 37% say that they typically treat secondary prevention patients to these targets in everyday practice, with the resources they have available.1 Overall, only 8% of GPs questioned believed that patients at high risk of cardiovascular disease (secondary prevention, type 2 diabetes, familial hypercholesterolaemia) currently have their lipids managed in line with NICE guidelines.1

Dr Findlay continued, "It is encouraging that GPs, who are at the forefront of lipid management, are aware of the NICE recommendations. However, they are still facing considerable challenges in getting these patients, who are at the highest cardiovascular risk, to the lower lipid levels that could further improve outcomes."

Support from other healthcare professionals for lower lipid targets in QOF

The support for specific lower lipid targets in QOF was even higher across other types of healthcare professionals surveyed (which included nurses, cardiologists and diabetologists), with 84% of cardiologists and 89% of diabetologists believing there should be lower lipid indicators for type 2 diabetes.1 Furthermore 86% of cardiologists and 92% of diabetologists agree that there should be lower lipid indicators for secondary prevention.1 Among the practice nurses questioned, 91% and 82% believe there should be lower lipid indicators for type 2 diabetes and secondary prevention, respectively.1

Source
Merck Sharp & Dohme and Schering-Plough